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MS2_1shot500

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Introduction Transanal endoscopic microsurgery ( TEM ) is a minimal invasive technique for local excision of rectal tumours . The procedure is performed via a rectoscope with a diametre of 4 cm . The aim of this prospect i ve study was to assess both functional outcome and quality of life after TEM . Patients and methods Between 2004 and 2006 , 47 patients were studied prior to and at least 6 months after TEM . Demographics , operative details and post-operative complications were recorded . Functional outcome was determined using the Faecal Incontinence Severity Index ( FISI ) . Quality of life was measured using the EuroQol EQ-5D question naire and the Faecal Incontinence Quality of Life ( FIQL ) score . Results Six months after surgery , median FISI score was found to be decreased ( p < 0.01 ) , depicting an improvement in faecal continence . This improvement was most significant in tumours within 7 cm from the dentate line ( p = 0.01 ) . From the patients ’ perspective , post-operative quality of life was found to be higher ( p < 0.02 ) . A significant improvement was observed in two of the four FIQLS domains ( embarrassment , p = 0.03 ; lifestyle , p = 0.05 ) . The domains of lifestyle , coping and behaviour and embarrassment were correlated with the FISI ( all p < 0.05 ) . Conclusion This study indicates TEM has no deteriorating effect on faecal continence . Moreover , once the tumour has been excised using TEM , quality of life is improved A prospect i ve study of clinical , manometric and proctographic results in 36 patients presenting for transanal endoscopic microsurgery was performed . Anorectal manometry showed no difference in maximal squeeze pressure before and 12 months after operation , but resting pressures were lower after surgery ( mean(s.e.m . ) preoperative 86.1(27.6 ) mmHg versus postoperative 67.2(23.2 ) mmHg , P<0.05 ) . The rectoanal inhibitory reflex was lost in a significant group of patients ( reflex present in 34 of 36 patients before operation and in 27 of 36 12 months after operation , P<0.05 ) . Proctography , manometry and question naire showed preserved function of most modalities 12 months after operation such that if objective function was impaired clinical function was adequate Background : The aim of this study was to evaluate the feasibility , safety , perioperative morbidity , and short-term outcomes of the transanal minimally invasive surgery ( TAMIS ) technique . Methods : This is a descriptive review of prospect ively collected data from 32 consecutive patients who underwent TAMIS procedures in our colorectal unit over a 40-month period . GelPOINT Path port was used in all cases . Demographic data , indications , tumor characteristics , morbidity , and follow-up data were collected . Primary endpoints included feasibility , safety , perioperative morbidity , and resection quality . Results : Fifteen adenomas , 12 carcinomas , 1 gastrointestinal stromal tumor , and 1 neuroendocrine tumor were locally excised . Additionally , 3 pelvic abscesses were drained transanally using the TAMIS port . Mean distance from the anal verge was 5.6 ± 1.5 cm . Early postoperative complications occurred in 22 % , with only one case of major complication ( 3.1 % ) requiring reoperation , and no postoperative mortality . Four carcinomas were understaged ( 33.3 % ) and 1 adenoma overstaged ( 6.7 % ) preoperatively . Three carcinomas were not suspected preoperatively ( 25 % ) . Microscopic positive lateral margin was found in one case , and no affected deep margin was found . Fragmentation rate was 6.9 % , 2 cases , both lesions over 20 cm2 . In cases of fit patients with high-risk carcinomas , 2 underwent immediate salvage surgery and another 2 refused and were treated with adjuvant radiotherapy . With a median follow-up of 26 months , the overall recurrence rate was 10.3 % , 1 adenoma and 2 carcinomas . Conclusion : TAMIS seems to be a safe and reproducible procedure for local excision of well-selected rectal lesions with low morbidity and good functional outcomes Background Transanal minimally invasive surgery ( TAMIS ) is emerging as an alternative to transanal endoscopic microsurgery . Quality of life ( QOL ) and functional outcome are important aspects when valuing a new technique . The aim of this prospect i ve study was to assess both functional outcome and QOL after TAMIS . Methods From 2011 to 2013 , patients were prospect ively studied prior to and at least 6 months after TAMIS for rectal adenomas and low-risk T1 carcinomas using a single-site laparoscopy port . Functional outcome was determined using the Faecal Incontinence Severity Index ( FISI ) . Quality of life was measured using functional [ Faecal Incontinence Quality of Life ( FIQL ) ] and generic ( EuroQol EQ-5D ) question naires . Results The study population consisted of 24 patients 13 men , median age 59 ( range 42–83 ) with 24 tumours [ median distance from the dentate line 8 cm ( range 2–17 cm ) ; median tumour size 6 cm2 ( range 0.25–51 cm2 ) ; 20 adenomas ; 4 low-risk T1 carcinomas ] . Post-operative complications occurred in one patient ( 4 % ; grade IIIb according to Clavien Dindo classification ) . Compared to baseline , FISI remained unaffected ( 9.8 vs 7.3 ; P = 0.26 ) , FIQL remained unaffected , and EuroQol EQ-5D improved ( EQ-VAS : 77 vs 83 ; P = 0.04 ) . Conclusion There was no detrimental effect of TAMIS on anorectal function . Overall QOL was improved after TAMIS , probably due to removal of the tumour , and at 6 months was equal to the general population PURPOSE : The Swedish Rectal Cancer Trial has unequivocally demonstrated that preoperative high-dose ( 5 × 5 Gy ) radiotherapy reduces local failure rates and improves overall survival . This will have an impact on the primary treatment of rectal cancer . This study investigates the effect of preoperative high-dose radiotherapy on long-term bowel function in patients treated with anterior resection . METHODS : A question naire was answered by 92 percent ( 203/220 ) of patients who were included in the Swedish Rectal Cancer Trial and who were alive after a minimum of five years . Thirty-two patients were excluded , mainly because of postoperative stomas and dementia , which left 171 for analysis . RESULTS : Median bowel frequency per week was 20 in the irradiated group ( n=84 ) and 10 in the surgery-alone group ( n=87;P<0.001 ) . Incontinence for loose stools ( P<0.001 ) , urgency ( P<0.001 ) , and emptying difficulties ( P<0.05 ) were all more common after irradiation . Sensory functions such as “ discrimination between gas and stool ” and “ ability to safely release flatus ” did not , however , differ between groups . Thirty percent of the irradiated group stated that they had an impaired social life because of bowel dysfunction , compared with 10 percent of the surgery-alone group ( P<0.01 ) . CONCLUSIONS : The study indicates that high-dose radiotherapy influences long-term bowel function , thus emphasizing the need for finding predictive factors for local recurrence to exclude patients with a very high probability for cure with surgery alone and to use optimized radiation techniques BACKGROUND : Currently , the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery , avoiding rectal resection . Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments . This method is less expensive as compared with transanal endoscopic microsurgery , relatively easy to learn , and available . Despite wide adoption of transanal minimally invasive surgery , to date only a few series on the implementation and use of this technique are reported , and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available . OBJECTIVE : The purpose of this work was to prospect ively assess the functional outcome after transanal minimally invasive surgery using the Fecal Incontinence Severity Index preoperatively and postoperatively . DESIGN : This was a prospect i ve cohort study . SETTING S : The study was conducted at a large teaching hospital . PATIENTS : Patients included those who underwent transanal minimally invasive surgery between October 2011 and September 2013 . INTERVENTIONS : Transanal minimally invasive surgery was studied . MAIN OUTCOME MEASURES : We measured postoperative surgical and functional results . RESULTS : A total of 37 patients underwent transanal minimally invasive surgery during our study period . Short-term morbidity rate was 14 % , and positive resection margins were reported in 6 cases ( 16 % ) ; in 1 of these patients , a local recurrence was observed . Overall , there was a significant decline in preoperative and postoperative Fecal Incontinence Severity Index scores ( p = 0.02 ) , indicating an improvement in anorectal function after transanal minimally invasive surgery for patients with impaired preoperative continence . Seventeen patients ( 49 % ) had impaired continence before transanal minimally invasive surgery ( mean Fecal Incontinence Severity Index score = 21 ) . Continence improved in 15 ( 88 % ) of these patients after surgery ; no change was observed in 1 patient ( 6 % ) , and continence further decreased in another . In addition , 18 patients ( 51 % ) had normal preoperative continence ( Fecal Incontinence Severity Index score = 0 ) , of which 83 % had no change in functionality , and continence decreased in 3 . LIMITATIONS : No quality of life was measured . CONCLUSIONS : Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment . More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance Abstract PURPOSE : There is accumulating evidence , both quantitative and qualitative , that pelvic irradiation adversely affects anorectal function . However , histologic evidence of sphincter injury has not been demonstrated . This study was design ed to perform histologic assessment of collagen deposition and nerve alteration in the internal anal sphincters of rectal cancer patients who underwent abdominoperineal resection after adjuvant chemoradiation therapy and to correlate the degree of histologic changes with the time interval between chemoradiotherapy and abdominoperineal resection . METHODS : Anal canal specimens were prospect ively collected in patients undergoing abdominoperineal resection . Representative slides were cut transversely at the level of the dentate line . Using trichrome and S-100 protein staining , a single pathologist blinded to the patients ’ treatment assessed collagen deposition and nerve fiber densities in the internal anal sphincter , respectively . RESULTS : Twelve patients received radiation for rectal cancer ( chemoradiotherapy group ) and six were treated by surgery alone , including four patients with rectal cancer ( 1 leiomyosarcoma ) and two with Crohn ’s disease ( control group ) . There was a trend toward increased fibrosis ( replacement of > 10 percent of normal structures by collagen ) and nerve density in the chemoradiotherapy group compared with the control group ( P = 0.08 and P = 0.05 , respectively ) . Nerve density significantly increased as chemoradiotherapy to abdominoperineal resection interval increased ( P = 0.04 ) . CONCLUSIONS : Pelvic irradiation results in damage to the myenteric plexus of the internal anal sphincter of patients with rectal cancer ; these alterations seem to be time-dependent . A trend toward increased collagen deposition also was observed . Together , these results provide a morphologic basis , which concurs to previously described physiologic and clinical alterations in the anal sphincter of patients irradiated for rectal cancer PURPOSE Preoperative short-term radiotherapy improves local control in patients treated with total mesorectal excision ( TME ) . This study was performed to assess the presence and magnitude of long-term side effects of preoperative 5 x 5 Gy radiotherapy and TME . Also , hospital treatment was recorded for diseases possibly related to late side effects of rectal cancer treatment . PATIENTS AND METHODS Long-term morbidity was assessed in patients from the prospect i ve r and omized TME trial , which investigated the efficacy of 5 x 5 Gy before TME surgery for mobile rectal cancer . Dutch patients without recurrent disease were sent a question naire . RESULTS Results were obtained from 597 patients , with a median follow-up of 5.1 years . Stoma function , urinary function , and hospital treatment rates did not differ significantly between the treatment arms . However , irradiated patients , compared with nonirradiated patients , reported increased rates of fecal incontinence ( 62 % v 38 % , respectively ; P < .001 ) , pad wearing as a result of incontinence ( 56 % v 33 % , respectively ; P < .001 ) , anal blood loss ( 11 % v 3 % , respectively ; P = .004 ) , and mucus loss ( 27 % v 15 % , respectively ; P = .005 ) . Satisfaction with bow Output:

Conclusions These techniques do not seem to affect continence by themselves except in minor cases .

MS2_1shot501

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Summary Background The international st and ard radiotherapy schedule for early breast cancer delivers 50 Gy in 25 fractions of 2·0 Gy over 5 weeks , but there is a long history of non-st and ard regimens delivering a lower total dose using fewer , larger fractions ( hypofractionation ) . We aim ed to test the benefits of radiotherapy schedules using fraction sizes larger than 2·0 Gy in terms of local-regional tumour control , normal tissue responses , quality of life , and economic consequences in women prescribed post-operative radiotherapy . Methods Between 1999 and 2001 , 2215 women with early breast cancer ( pT1 - 3a pN0 - 1 M0 ) at 23 centres in the UK were r and omly assigned after primary surgery to receive 50 Gy in 25 fractions of 2·0 Gy over 5 weeks or 40 Gy in 15 fractions of 2·67 Gy over 3 weeks . Women were eligible for the trial if they were aged over 18 years , did not have an immediate reconstruction , and were available for follow-up . R and omisation method was computer generated and was not blinded . The protocol -specified principal endpoints were local-regional tumour relapse , defined as reappearance of cancer at irradiated sites , late normal tissue effects , and quality of life . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59368779 . Findings 1105 women were assigned to the 50 Gy group and 1110 to the 40 Gy group . After a median follow up of 6·0 years ( IQR 5·0–6·2 ) the rate of local-regional tumour relapse at 5 years was 2·2 % ( 95 % CI 1·3–3·1 ) in the 40 Gy group and 3·3 % ( 95 % CI 2·2 to 4·5 ) in the 50 Gy group , representing an absolute difference of −0·7 % ( 95 % CI −1·7 % to 0·9%)—ie , the absolute difference in local-regional relapse could be up to 1·7 % better and at most 1 % worse after 40 Gy than after 50 Gy . Photographic and patient self- assessment s indicated lower rates of late adverse effects after 40 Gy than after 50 Gy . Interpretation A radiation schedule delivering 40 Gy in 15 fractions seems to offer rates of local-regional tumour relapse and late adverse effects at least as favourable as the st and ard schedule of 50 Gy in 25 fractions OBJECTIVE Concomitant chemo-radiotherapy after modified radical mastectomy for breast cancer is an effective means of achieving high survival rates . In this study different radiotherapy optimization regimens are compared to assess their effectiveness and toxicity rates . PATIENTS AND METHODS 112 patients with modified radical mastectomy participated , and were r and omly assigned to one of three groups , all receiving adjuvant chemotherapy for 4 - 6 weeks prior to radiotherapy : group A received intensity modulated radiotherapy ( radiation dose ( DT ) 50 Gy , 2.0 Gy/fraction , 25 times , during the course of 33 - 35 days ) ; group B received concurrent radio chemotherapy and intensity modulated radiotherapy ; and group C adopted concurrent radio chemotherapy and hypofractionation ( DT of 42.56 Gy , 2.66Gy/fraction , 16 times , during the course of 22 - 24 days ) with 37 cases . The occurrence of acute and chronic radiation injuries , the cancer recurrence and the survival rates were compared , and a dose volume histogram ( DVH ) was created . RESULTS The total prevalence and survival rates of Group C were significantly better than those of the other two groups ( p ≤ 0.05 ) ; in spite of the fact that the local recurrence and distant metastasis rates separately were all statistically the same ( p ≥ 0.05 ) . Also , the total radiation injury occurrence of group C was significantly lower ( p < 0.05 ) ; but no significant differences were found when singling out acute and chronic injury occurrences or injury severity between the three groups . The values of V5 , V10 , V20 and V30 increased gradually in all of the groups , and V5 and V10 in Group C were higher than those in the other two groups , but the comparison between V20 and V30 yielded no statistically significant differences . CONCLUSIONS Based on these results , the concurrence of hypo-fractionation radiotherapy and chemotherapy may be an effective and safe approach for cancer treatment after modified radical mastectomy , and larger studies are warranted given the convenience of the method BACKGROUND 5-year results of the UK St and ardisation of Breast Radiotherapy ( START ) trials suggested that lower total doses of radiotherapy delivered in fewer , larger doses ( fractions ) are at least as safe and effective as the historical st and ard regimen ( 50 Gy in 25 fractions ) for women after primary surgery for early breast cancer . In this prespecified analysis , we report the 10-year follow-up of the START trials testing 13 fraction and 15 fraction regimens . METHODS From 1999 to 2002 , women with completely excised invasive breast cancer ( pT1 - 3a , pN0 - 1 , M0 ) were enrolled from 35 UK radiotherapy centres . Patients were r and omly assigned to a treatment regimen after primary surgery followed by chemotherapy and endocrine treatment ( where prescribed ) . R and omisation was computer-generated and stratified by centre , type of primary surgery ( breast-conservation surgery or mastectomy ) , and tumour bed boost radiotherapy . In START-A , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 41·6 Gy or 39 Gy in 13 fractions over 5 weeks . In START-B , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 40 Gy in 15 fractions over 3 weeks . Eligibility criteria included age older than 18 years and no immediate surgical reconstruction . Primary endpoints were local-regional tumour relapse and late normal tissue effects . Analysis was by intention to treat . Follow-up data are still being collected . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59368779 . FINDINGS START-A enrolled 2236 women . Median follow-up was 9·3 years ( IQR 8·0 - 10·0 ) , after which 139 local-regional relapses had occurred . 10-year rates of local-regional relapse did not differ significantly between the 41·6 Gy and 50 Gy regimen groups ( 6·3 % , 95 % CI 4·7 - 8·5 vs 7·4 % , 5·5 - 10·0 ; hazard ratio [ HR ] 0·91 , 95 % CI 0·59 - 1·38 ; p=0·65 ) or the 39 Gy ( 8·8 % , 95 % CI 6·7 - 11·4 ) and 50 Gy regimen groups ( HR 1·18 , 95 % CI 0·79 - 1·76 ; p=0·41 ) . In START-A , moderate or marked breast in duration , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 39 Gy group than in the 50 Gy group . Normal tissue effects did not differ significantly between 41·6 Gy and 50 Gy groups . START-B enrolled 2215 women . Median follow-up was 9·9 years ( IQR 7·5 - 10·1 ) , after which 95 local-regional relapses had occurred . The proportion of patients with local-regional relapse at 10 years did not differ significantly between the 40 Gy group ( 4·3 % , 95 % CI 3·2 - 5·9 ) and the 50 Gy group ( 5·5 % , 95 % CI 4·2 - 7·2 ; HR 0·77 , 95 % CI 0·51 - 1·16 ; p=0·21 ) . In START-B , breast shrinkage , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 40 Gy group than in the 50 Gy group . INTERPRETATION Long-term follow-up confirms that appropriately dosed hypofractionated radiotherapy is safe and effective for patients with early breast cancer . The results support the continued use of 40 Gy in 15 fractions , which has already been adopted by most UK centres as the st and ard of care for women requiring adjuvant radiotherapy for invasive early breast cancer . FUNDING Cancer Research UK , UK Medical Research Council , UK Department of Health Purpose Conventionally fractionated postmastectomy radiation therapy ( PMRT ) takes approximately 5 to 6 weeks . Data supporting hypofractionated PMRT is limited . We prospect ively evaluated a short course of hypofractionated PMRT , in which therapy was completed in 15 treatment days . Patients and Methods We delivered PMRT at a dose of 36.63 Gy in 11 fractions of 3.33 Gy over 11 days to the chest wall and the draining regional lymph nodes , followed by an optional mastectomy scar boost of four fractions of 3.33 Gy . Our primary end point was freedom from any grade 3 or higher toxicities . We incorporated early stopping criteria on the basis of predefined toxicity thresholds . Results We enrolled 69 women with stage II to IIIa breast cancer , of whom 67 were eligible for analysis . After a median follow-up of 32 months , there were no grade 3 toxicities . There were 29 reported grade 2 toxicities , with grade 2 skin toxicities being the most frequent ( 16 of 67 ; 24 % ) . There were two patients with isolated ipsilateral chest wall tumor recurrences ( 2 of 67 ; crude rate , 3 % ) . Three-year estimated local recurrence-free survival was 89.2 % ( 95 % CI , 0.748 to 0.956 ) . The 3-year estimated distant recurrence-free survival was 90.3 % ( 95 % CI , 0.797 to 0.956 ) . Forty-one patients had chest wall reconstructions ; three had exp and ers removed for infection before radiation therapy . The total rate of implant loss or failure was 24 % ( 9 of 38 ) , and the unplanned surgical correction rate was 8 % ( 3 of 38 ) , for a total complication rate of 32 % . Conclusion To our knowledge , our phase II prospect i ve study offers one of the shortest courses of PMRT reported , delivered in 11 fractions to the chest wall and nodes and 15 fractions inclusive of a boost . We demonstrated low toxicity and high local control with this schedule . On the basis of our data , we have design ed a cooperative group phase III prospect i ve , r and omized trial of conventional versus hypofractionated PMRT that will activate soon Introduction : The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients . Methods : 3 irradiation schedules were analyzed : 48.30 Gy in 21 fractions ( group A , n = 60 ) , 42.56 Gy in 16 fractions ( group B , n = 27 ) and 50 Gy in 25 fractions ( group C , n = 30 ) of the front chest wall . All groups were also treated with a supraclavicular field , with 39.10 Gy in 17 fractions ( group A ) , 37.24 Gy in 14 fractions ( group B ) or 45 Gy in 25 fractions ( group C ) . Results : No local recurrences were noted in any group during 36 months of follow-up . Acute skin toxicity presented in all groups , with 58.3 % , 70.4 % and 60 % of grade I ; 35 % , 25.9 % and 40 % of grade II ; 6.7 % , 3.7 % and 0 % of grade III being seen in groups A , B and C , respectively . Late skin toxicity was noted only as grade I in 16.7 % , 25.9 % and 26.7 % of groups A , B and C , respectively . No significant difference was noted among all groups for either acute or late skin toxicity , or for radio-pneumonitis ( chi2 test , p > 0.05 ) . Conclusion : All schedules were equally effective with equivalent toxicity . A prospect i ve r and omized study is needed to confirm our results Background Several r and omized trials and meta-analyses confirmed a wide benefit of radiotherapy ( RT ) , both after breast conserving surgery ( BCS ) and mastectomy . However , many elderly women do n't receive RT . Hypofractionated ( HF ) RT allows « simplified » and more accessible treatments with equivalent results to classic RT in three large r and omized trials . However , there are few available data on HF-RT for nodal irradiation , as well as for the boost . Methods We evaluated patients treated for IBC by HF-RT between 2004 and 2012 in two regional cancer centres . We used an original scheme delivering 45 Gy in 15 fractions three times a week , both after BCS or mastectomy , with or without nodal irradiation . After BCS , a 9 Gy boost in 3 fractions was delivered . Local , regional and distant recurrences were assessed , as well as acute and late cutaneous , cardiac or pulmonary toxicities . Results Output:

Conclusions The results of this study show that compared to conventional fractionated radiotherapy , hypofractionated radiotherapy is not significantly different with respect to efficacy or toxicity in postmastectomy breast cancer .

MS2_1shot502

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND There is a need to assess the sensitivity , specificity , and predictive value of endoscopic ultrasonography ( EUS ) in the diagnosis and staging of gastric cancer and lymphoma . METHODS A prospect i ve study was performed on 86 patients with endoscopic gross appearance suspicious for cancer or lymphoma . Biopsies with endoscopic forceps were always carried out before EUS . All patients underwent laparotomy for final diagnosis , staging , and eventually treatment . The results of EUS were correlated with the histologic findings of the resected specimens , when possible , or with the surgical findings . There were 42 gastric cancers and 44 primary gastric lymphomas . RESULTS EUS made a correct diagnosis of cancer in 35 of 42 patients , with a sensitivity of 83 % . Positive predictability was 87 % , specificity was 97 % , and negative predictability was 96 % . Diagnostic accuracy was 95 % . In the evaluation of cancer depth invasion , EUS was correct in 91 % of cases . EUS displayed perigastric metastatic lymph nodes in 14 of 25 patients , with a sensitivity of 56 % . Positive predictive value was 93 % , specificity was 93 % , and negative predictive value was 54 % . Diagnostic accuracy was 69 % . EUS made a correct diagnosis of lymphoma in 39 of 44 patients , with a sensitivity of 89 % . Positive predictability was 87 % , specificity was 97 % , and negative predictability was 97 % . Diagnostic accuracy was 95 % . In the evaluation of lymphoma depth invasion , EUS was correct in 92 % of cases . EUS displayed metastatic perigastric lymph nodes in 8 of 18 patients , with a sensitivity of 44 % . Positive predictability was 100 % , specificity was 100 % , and negative predictability was 72 % . Diagnostic accuracy was 77 % . CONCLUSIONS From these data it appears that in these diseases EUS has demonstrated specific ultrasonographic features that allow correct diagnosis and staging in the majority of patients . In difficult cases EUS may help to achieve the correct diagnosis . EUS also appear to be a useful tool for staging of gastric cancer and lymphoma . It shows not only tumor depth and local spread but also the passage from a pathologic to a normal wall and lymph node metastasis . With this accurate noninvasive staging procedure , in the near future many patients will no longer undergo exploratory laparotomy for surgical staging . Thanks to EUS , the choice of conservative or surgical treatment can be strongly affected . In case of surgery , EUS can orient the kind of surgical approach . Moreover , the use of EUS for evaluation of therapy during follow-up will probably become of major importance Prospect ively , 72 patients with a gastric carcinoma were studied endosonographically before surgery . The results were correlated with those obtained with the histology of resected specimens according to the new ( 1987 ) TNM classification . Endoscopic ultrasonography ( EUS ) was accurate in assessing the extent and depth of tumor infiltration . Early gastric carcinoma could readily be distinguished from advanced carcinoma . The overall accuracy of EUS was 84.7 % . Occasionally , overstaging and understaging occurred . Stenosis was a factor limiting accurate staging . EUS was reasonably accurate in the assessment of lymph node metastasis . The overall accuracy was 81.0 % . In non-metastatic lymph nodes , however , the accuracy was only 50 % . Difficulties occurred in distinguishing granulomatous lymph nodes and small micrometastatic lymph node involvement . EUS was not accurate in diagnosing distant metastasis , due to the limited depth of penetration of ultrasound . Technical improvements such as a reduction in the diameter of the echoprobe , and the use of the biopsy channel for EUS-guided cytological puncture will further enhance the accuracy of EUS Strategies for the treatment of cancer of the oesophagus depend on the tumour stage at the time of diagnosis . Resection , the only curative treatment , is confined to early tumour stages . Tumours with local infiltration are usually unresectable and require palliative treatment . Computed tomography has been widely used for preoperative staging but often fails to define this correctly . Endoscopic ultrasound allows direct visualisation of the parietal wall and may be useful in staging gastrointestinal tumours . In a comparative prospect i ve study , 52 patients with tumours of the oesophagus were investigated preoperatively both by endoscopic ultrasound and computed tomography to determine the stage of tumour infiltration and local lymph node involvement . Thirty seven of these patients underwent operation , resection , or dissection and entered the study . The intraoperative findings or the histopathological assessment , or both , were taken as a reference . For all TN stages of oesophageal tumours , correct preoperative staging was accomplished by endoscopic ultrasound in 89 % for T stage and 69 % for N stage compared with 51 % and 51 % respectively by computed tomography ( highly significant using Fisher 's exact test ) . This study shows that endoscopic ultrasound is useful in preoperative TN staging of tumours of the oesophagus The dem and for evidence -based healthcare is increasing nationally and internationally and it is equally necessary in both diagnostic and therapeutic practice . Evidence may be collected and combined by means of a systematic literature review of published and unpublished data on a well-defined topic . The output of such review s is then available to guide health policy , influence good practice or direct research . Published guidelines are available on the performance of systematic review s , especially those of r and omized controlled trials . Although there is an extensive literature base of research data in diagnostic imaging there are few such trials , but it is still possible to perform systematic review s. With the alternative study design s encountered it is important to be aware of the main threats to study validity . In this paper the biases likely to be encountered in studies of diagnostic performance are review ed , with particular reference to diagnostic imaging tests . The biases are sub-divided into three categories . The first category is patient selection and covers the validity of generalizing results beyond the study population . The other two , concerning study design and execution and the interpretation of results , affect the likely validity of the results of a study . An underst and ing of these factors is an essential prerequisite for those undertaking or using a systematic literature review in the field of diagnostic imaging . The definitions form the foundations of a defensible review protocol From 1986 to 1990 a prospect i ve comparative study was undertaken to compare the relative accuracy of computed tomography , endogastric ultrasonography , and intraoperative surgical assessment in evaluating the depth of invasion ( T category ) and involvement of lymph nodes ( N category ) of patients with gastric carcinoma . One hundred and eight consecutive patients , who were treated by total gastrectomy and previously evaluated with computed tomography , endogastric ultrasonography , and intraoperative surgical assessment , entered the study . Results ( T and N category ) were compared with those of histopathological staging ( pT and pN category ) . T categories were correctly staged in 43 % of cases with computed tomography , 86 % with endogastric ultrasonography , and 56 % with intraoperative surgical assessment . Computed tomography scanning correctly staged 51 % of all N1 and N2 lymph nodes compared with 74 % for endogastric ultrasonography and 54 % for intraoperative surgical assessment . In general , computed tomography was more accurate for advanced stages of cancer and showed a tendency to overstage the T category and understage N category of gastric tumours . By contrast , endogastric ultrasonography was equally accurate for all T categories and showed an understaging for N categories . Intraoperative surgical assessment overstaged early T stages , understaged T4 tumours , and was equally accurate for all grade s of N categories . Computed tomography scanning and intraoperative surgical assessment of T and N categories were of little value in staging of gastric carcinoma . Endogastric ultrasonography is more accurate than computed tomography scanning and intraoperative surgical assessment . Therefore endogastric ultrasonography should be introduced in the preoperative assessment of patients with gastric carcinoma BACKGROUND Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma . We conducted a prospect i ve , r and omized trial comparing surgery alone with combined chemotherapy , radiotherapy , and surgery . METHODS Patients assigned to multimodal therapy received two courses of chemotherapy in weeks 1 and 6 ( fluorouracil , 15 mg per kilogram of body weight daily for five days , and cisplatin , 75 mg per square meter of body-surface area on day 7 ) and a course of radiotherapy ( 40 Gy , administered in 15 fractions over a three-week period , beginning concurrently with the first course of chemotherapy ) , followed by surgery . The patients assigned to surgery had no preoperative therapy . RESULTS Of the 58 patients assigned to multimodal therapy and the 55 assigned to surgery , 10 and 1 , respectively , were withdrawn for protocol violations . At the time of surgery , 23 of 55 patients ( 42 percent ) treated with preoperative multimodal therapy who could be evaluated had positive nodes or metastases , as compared with 45 of the 55 patients ( 82 percent ) who underwent surgery alone ( P<0.001 ) . Thirteen of the 52 patients ( 25 percent ) who underwent surgery after multimodal therapy had complete responses as determined pathologically . The median survival of patients assigned to multimodal therapy was 16 months , as compared with 11 months for those assigned to surgery alone ( P=0.01 ) . At one , two , and three years , 52 , 37 , and 32 percent , respectively , of patients assigned to multimodal therapy were alive , as compared with 44 , 26 , and 6 percent of those assigned to surgery , with the survival advantage favoring multimodal therapy reaching significance at three years ( P=0.01 ) . CONCLUSIONS Multimodal treatment is superior to surgery alone for patients with resectable adenocarcinoma of the esophagus The T stage is an important criterion for determining prognosis in esophageal carcinoma . Endosonography , although established as a highly accurate method in preoperative determination of the T stage , may be less reliable in non-traversable tumor stenoses . In a comparative prospect i ve study , 41 patients with carcinoma of the esophagus were investigated to determine the role of tumor stenosis on the accuracy of endosonography in preoperative T staging . The results were correlated with the histology of the resected specimen . The overall accuracy in T staging with endosonography was 76 % , compared with 49 % in computed tomography . T staging results of endosonography were good in easily and non-traversable stenoses ( 92 % , 87 % respectively ) , but lower accuracy was obtained in stenoses which could be traversed only with difficulty ( 46 % ) . Computed tomography was inferior to endosonography in all three groups of patients . The high accuracy of endosonography in non-traversable stenoses might be due to the fact that all tumors were in an advanced stage ( T3 or T4 ) . When passage of the echoendoscope proves difficult , the low focal distance between the ultrasonic transducer and tumor may hamper clear visualisation of the wall layers and tumor penetration depth . These limitations of endosonography should stimulate further efforts in improving ultrasonic resolution in these cases BACKGROUND AND STUDY AIMS Endosonographic staging of esophageal carcinoma may be limited by non-traversable tumor stenoses . Dilation of malignant esophageal strictures carries a significant risk of esophageal perforation . We therefore evaluated the use of ultrasonic miniprobes in the staging of stenotic esophageal carcinoma compared with conventional endoscopic ultrasound . PATIENTS AND METHODS In a blinded , prospect i ve study , which included histopathological evaluation , 53 consecutive patients ( 43 male , 10 female , mean age 61 years ) with stenosing esophageal carcinomas were examined preoperatively . Endosonography was done using the optical GF-UM3 echo endoscope . If tumor strictures were not traversable with this instrument , a blind esophagoprobe , the MH-908 was used for endosonography . Miniprobe sonography ( MPS ) was done during esophagoscopy in all patients . The various imaging modalities were assessed in terms of complete tumor traversability and correct tumor staging . Every patient underwent surgical tumor resection . RESULTS MPS of the esophagus and proximal parts of the stomach was possible in all 53 patients without prior dilation of tumor stenoses . Endosonography with the GF-UM3 instrument was precluded in 23 patients ( 43.4 % ) while in 20 of the latter patients the MH 908 esophagoprobe could be passed through tumor stenoses . The overall accuracy rates for depth of tumor infiltration ( T ) staging were : 62 % ( 31/50 ) for endosonography ( GF-UM3 plus esophagoprobe ) and 86.8 % ( 46/53 ) for MPS . The accuracy rates for T staging in tumors traversable both with the GF-UM3 echo endoscope and with miniprobes were 56.7 % ( 17/30 ) for GF-UM3 and 8 Output:

In articles that compared EUS directly with incremental computed tomography , EUS performed better . EUS is highly effective for discrimination of stages T1 and T2 from stages T3 and T4 for primary gastro-oesophageal carcinomas . The failure rate of EUS from non-traversability of a stenotic cancer may be a limitation in some patient groups

MS2_1shot503

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Cytoreductive surgery (CRS)/Hyperthermic Intraperitoneal Chemotherapy ( HIPEC ) is associated with prolonged survival in selected patients with peritoneal surface disease . Yet , for elderly patients ( older than 70 years of age ) CRS/HIPEC is controversial , due to associated morbidity . Methods A retrospective analysis of a prospect i ve data base of 950 procedures was performed . Type of malignancy , demographics , performance and resection status , hospitalization , morbidity , mortality , and survival were review ed . Results A total of 81 patients ( median age 73 , range 70–87 ) underwent CRS/HIPEC between 1991 and 2011 . Median follow-up was 48.1 months . Complete cytoreduction was achieved in 44 % . Median survival was 31.8 months for appendiceal cancer , 41.5 for mesothelioma , 54.0 for ovarian cancer , 13.2 for colon cancer , and 7.6 for gastric cancer . The 30-day mortality was 13.6 % . The combined grade III and IV morbidity was 38 % . Median ICU and hospital stay for uncomplicated patients was 1 and 8 days , respectively . The 3-month mortality was 27.4 % . There were no deaths in the octogenarian group . In stepwise multivariate analysis , type of primary ( p = 0.03 ) , albumin ( p = 0.02 ) , and R status ( p = 0.007 ) were predictive of survival only in the absence of complications . Splitting the data at the midpoint of surgical experience , there was a drop in 1- and 3-month mortality over time to 9.5 and 19.3 % , respectively , while the median survival increased from 11.2 ( N = 39 ) to 46.9 months ( N = 42 ) . Conclusions HIPEC in the elderly is associated with a steep learning curve and considerable morbidity and mortality . However , age alone is not a contraindication for the procedure . Institutional experience and stringent patient selection are key factors for prolonged survival Objective : The aim of this prospect i ve study was to analyze the impact of second-look surgery in an attempt to treat peritoneal carcinomatosis ( PC ) at an early stage in a series of patients at high risk of developing PC from colorectal cancer . Background : The prognosis of colorectal PC has recently been improved with hyperthermic intraperitoneal chemotherapy ( HIPEC ) after complete cytoreductive surgery ( CCRS ) , and could be further improved if PC could be treated at an early stage . But , currently , the diagnosis of early PC is not accessible to imaging . Patients and Methods : From 1999 to 2006 , 29 patients without any sign of recurrence on imaging studies underwent second-look surgery 13 months after resection of the primary tumor . Patients were selected according to primary tumor-associated criteria : resected minimal synchronous macroscopic PC ( n = 16 ) , synchronous ovarian metastases ( n = 4 ) , perforated primary tumor ( n = 9 ) . Results : PC was found and treated with CCRS plus HIPEC in 16 of 29 ( 55 % ) cases , corresponding to 10 of 16 patients with initial PC , 3 of 4 patients with synchronous ovarian metastases and 3 of 9 patients with a perforated primary tumor . There was no postoperative mortality , and morbidity ( grade III/IV ) occurred in 14 % of cases . After a median follow-up of 27 months ( range , 6–96 ) , 8 of 16 patients treated with CCRS and HIPEC are free of disease , 4 relapsed in the peritoneum , and 4 developed isolated visceral metastases . Conclusion : Performing second-look surgery at 1 year in selected patients at high risk of developing PC allowed the early detection and treatment of PC in 55 % of cases . Our preliminary results have encouraged us to pursue this strategy and to evaluate it in a prospect i ve multicenter trial Introduction The treatment of peritoneal carcinomatosis is based on cytoreduction followed by hyperthermic intraperitoneal chemotherapy and combined with adjuvant chemotherapy . In 2003 , a r and omized trial was finished comparing systemic chemotherapy alone with cytoreduction followed by hyperthermic intraperitoneal chemotherapy and systemic chemotherapy . This trial showed a positive result favoring the studied treatment . This trial has now been up date d to a minimal follow-up of 6 years to show long-term results . Patients and Methods For all patients still alive , the follow-up was up date d until 2007 . In the original study , four patients were excluded — two because of no eligible histology/pathology and two because of major protocol violations . After r and omization , four patients in the HIPEC arm and six in the control arm were not treated using the intended therapy , one patient because of withdrawal , one because of a life-threatening other malignant disease and the others because of progressive disease before initiation of the treatment . During the follow-up , one patient was crossed over from the control arm and underwent cytoreduction and HIPEC for recurrent disease , after the assigned treatment was completed . The data from these patients were censored at the moment of the cross-over . Progression-free and disease-specific survival were analyzed using the Kaplan Meyer test and compared using the log rank method . The long-term results were studied in more detail to evaluate efficacy and toxicity . Results At the time of this up date , the median follow-up was almost 8 years ( range 72–115 months ) . In the st and ard arm , 4 patients were still alive , 2 with and 2 without disease ; in the “ HIPEC ’ arm , 5 patients were still alive , 2 with and 3 without disease . The median progression-free survival was 7.7 months in the control arm and 12.6 months in the HIPEC arm ( P = 0.020 ) . The median disease-specific survival was 12.6 months in the control arm and 22.2 months in the HIPEC arm ( P = 0.028 ) . The 5-year survival was 45 % for those patients in whom a R1 resection was achieved . Conclusion With 90 % of all events having taken place up to this time , this r and omized trial shows that cytoreduction followed by HIPEC does significantly add survival time to patients affected by peritoneal carcinomatosis of colorectal origin . For a selected group , there is a possibility of long-term survival Background We evaluate the long-term survival of patients with peritoneal carcinomatosis ( PC ) treated with systemic chemotherapy regimens , and the impact of the of the retrospective peritoneal disease severity score ( PSDSS ) on outcomes . Methods One hundred sixty-seven consecutive patients treated with PC from colorectal cancer between years 1987 - 2006 were identified from a prospect i ve institutional data base . These patients either received no chemotherapy , 5-FU/Leucovorin or Oxaliplatin/Irinotecan-based chemotherapy . Stratification was made according to the retrospective PSDSS that classifies PC patients based on clinical ly relevant factors . Survival analysis was performed using the Kaplan-Meier method and comparison with the log-rank test . Results Median survival was 5 months ( 95 % CI , 3 - 7 months ) for patients who had no chemotherapy , 11 months ( 95 % CI , 6 - 9 months ) for patients treated with 5 FU/LV , and 12 months ( 95 % CI , 4 - 20 months ) for patients treated with Oxaliplatin/Irinotecan-based chemotherapy . Survival differed between patients treated with chemotherapy compared to those patients who did not receive chemotherapy ( p = 0.026 ) . PSDSS staging was identified as an independent predictor for survival on multivariate analysis [ RR 2.8 ( 95%CI 1.5 - 5.4 ) ; p < 0.001 ] . Conclusion A trend towards improved outcomes is demonstrated from treatment of patients with PC from colorectal cancer using modern systemic chemotherapy . The PSDSS appears to be a useful tool in patient selection and prognostication in PC of colorectal origin Purpose This nationwide study evaluated results of cytoreductive surgery ( CRS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for peritoneal metastasis of colorectal origin in the Netherl and s following a national protocol . Methods In a multi-institutional study prospect i ve data bases of patients with peritoneal carcinomatosis ( PC ) from colorectal cancer and pseudomyxoma peritonei ( PMP ) treated according to the Dutch HIPEC protocol , a uniform approach for the CRS and HIPEC treatment , were review ed . Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival . Results Nine-hundred sixty patients were included ; 660 patients ( 69 % ) were affected by PC of colorectal carcinoma and the remaining suffered from PMP ( 31 % ) . In 767 procedures ( 80 % ) , macroscopic complete cytoreduction was achieved . Three-hundred and thirty one patients had grade III – V complications ( 34 % ) . Thirty-two patients died perioperatively ( 3 % ) . Median length of hospital stay was 16 days ( range 0–166 days ) . Median follow-up period was 41 months ( 95 % confidence interval ( CI ) , 36–46 months ) . Median progression-free survival was 15 months ( 95 % CI 13–17 months ) for CRC patients and 53 months ( 95 % CI 40–66 months ) for PMP patients . Overall median survival was 33 ( 95 % CI 28–38 months ) months for CRC patients and 130 months ( 95 % CI 98–162 months ) for PMP patients . Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients . Conclusions The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP . It is assumed the uniform Dutch HIPEC protocol was beneficial Background To prospect ively investigate the diagnostic accuracy of a 64-section multi-detector row computed tomography ( CT ) for the detection of peritoneal metastases , with the use of surgery and histopathological findings as the reference st and ard . Methods The study cohort comprised 18 patients with peritoneal carcinomatosis who underwent multiphasic CT with a 64-section CT , 0–119 days before cytoreductive surgery . Transverse CT images along with isotropic reformatted coronal and sagittal images were prospect ively and independently evaluated by one of the five staff radiologists in an unblinded fashion . Results The overall sensitivity , specificity , positive , and negative predictive values of CT for the detection of peritoneal metastases were , respectively , 75 % ( 93 of 124 lesions ; confidence interval [ CI ] 68–84 ) , 92 % ( 118 of 128 ; CI 85–96 ) , 90 % ( 93 of 103 ; CI 83–95 ) , and 79 % ( 118 of 149 ; CI 72–86 ) . For lesions 0.5 cm in diameter or larger , CT yielded a mean sensitivity of 89 % ( 77 of 87 ; CI 75–97 ) , although sensitivity decreased to only 43 % ( 16 of 37 ; CI 28–56 ) for lesions < 0.5 cm in diameter . Conclusions 64-Section CT with the addition of isotropic reformatted coronal and sagittal images is a very effective technique in the detection of peritoneal metastases of 0.5 cm in diameter or larger , although sensitivity decreases remarkably for lesions < 0.5 cm in diameter AIM The present study was specifically design ed to assess the major clinical and pathological variables of patients with colorectal peritoneal carcinomatosis in order to investigate whether currently used criteria appropriately select c and i date s for peritonectomy procedures ( cytoreductive surgery ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) . PATIENTS AND METHODS Preoperative , operative and follow-up data on 146 consecutive patients presenting with peritoneal carcinomatosis of colorectal origin and treated by surgical cytoreduction combined with HIPEC in 5 Italian Hospital and University Centers were prospect ively entered in a common data base . Univariate and multivariate analyses were used to assess the prognostic value of clinical and pathologic factors . RESULTS Over a minimum 24-month follow-up , the overall morbidity rate was 27.4 % ( mortality rate : 2.7 % ) and was directly related to the extent of surgery . Peritoneal cancer index ( PCI ) , unfavorable peritoneal sites , synchronous or previously resected liver metastasis and the completeness of cytoreduction , all emerged as independent prognostic factors correlated with survival . CONCLUSIONS Until research provides more effective criteria for selecting patients based upon the biomolecular features of carcinomatosis , patients should be selected according to the existing independent prognostic variables PURPOSE Symptoms and complications of metastatic colorectal cancer ( mCRC ) differ by metastatic sites . There is a paucity of prospect i ve survival data for patients with peritoneal carcinomatosis colorectal cancer Output:

Substantial consensus was also reached on the benefit of multidisciplinary team discussion and the achievability of a ( near ) complete cytoreduction ( CC0 - 1 ) without supporting evidence .

MS2_1shot504

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective Mechanical factors , in particular increased medial knee joint load , are believed to be important in the structural progression of knee osteoarthritis . This study evaluated the relationship of medial knee load during walking to indices of structural disease progression , measured on MRI , in people with medial knee osteoarthritis . Methods A longitudinal cohort design utilising a subset of participants ( n=144 , 72 % ) enrolled in a r and omised controlled trial of lateral wedge insoles was employed . Medial knee load parameters including the peak knee adduction moment ( KAM ) and the KAM impulse were measured at baseline using three-dimensional gait analysis during walking . MRI at baseline and at 12 months was used to assess structural indices . Multiple regression with adjustment for covariates assessed the relationship between medial knee load parameters and the annual change in medial tibial cartilage volume . Binary logistic regression was used for the dichotomous variables of progression of medial tibiofemoral cartilage defects and bone marrow lesions ( BML ) . Results A higher KAM impulse , but not peak KAM , at baseline was independently associated with greater loss of medial tibial cartilage volume over 12 months ( β=29.9 , 95 % CI 6.3 to 53.5 , p=0.01 ) . No significant relationships were seen between medial knee load parameters and the progression of medial tibiofemoral cartilage defects or BML . Conclusion This study suggests knee loading , in particular the KAM impulse , may be a risk factor for loss of medial tibial cartilage volume . As knee load is modifiable , load-modifying treatments may potentially slow disease progression Background There is controversial evidence regarding whether foot orthoses or knee braces improve pain and function or correct malalignment in selected patients with osteoarthritis ( OA ) of the medial knee compartment . However , insoles are safe and less costly than knee bracing if they relieve pain or improve function . Questions / purpose sWe therefore asked whether laterally wedged insoles or valgus braces would reduce pain , enhance functional scores , and correct varus malalignment comparable to knee braces . Patients and Methods We prospect ively enrolled 91 patients with symptomatic medial compartmental knee OA and r and omized to treatment with either a 10-mm laterally wedged insole ( index group , n = 45 ) or a valgus brace ( control group , n = 46 ) . All patients were assessed at 6 months . The primary outcome measure was pain severity as measured on a visual analog scale . Secondary outcome measures were knee function score using WOMAC and correction of varus alignment on AP whole-leg radiographs taken with the patient in the st and ing position . Additionally , we compared the percentage of responders according to the OMERACT-OARSI criteria for both groups . Results We observed no differences in pain or WOMAC scores between the two groups . Neither device achieved correction of knee varus malalignment in the frontal plane . According to the OMERACT-OARSI criteria , 17 % of our patients responded to the allocated intervention . Patients in the insole group complied better with their intervention . Although subgroup analysis results should be translated into practice cautiously , we observed a slightly higher percentage of responders for the insole compared with bracing for patients with mild medial OA . Conclusions Our data suggest a laterally wedged insole may be an alternative to valgus bracing for noninvasively treating symptoms of medial knee OA.Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of level of evidence We examined if a subject-specific amount of lateral wedge added to a foot orthosis could alter knee mechanics to potentially reduce the progression of knee osteoarthritis in patients with medial knee osteoarthritis . Twenty individuals with medial knee osteoarthritis ( > /=2 Kellgren Lawrence grade ) were prescribed a custom laterally wedged foot orthotic device . The prescribed wedge amount was the minimal wedge amount that provided the maximum amount of pain reduction during a lateral step-down test . Following an accommodation period , all subjects returned to the laboratory for a gait analysis . Knee mechanics were collected as the subjects walked at an intentional walking speed . Walking in the laterally wedged orthotic device significantly reduced the peak adduction moment during early stance ( p < 0.01 ) compared to the nonwedged device . Similarly , the wedged orthotic device significantly reduced the knee adduction excursion from heel strike to peak adduction ( p < 0.01 ) compared to the nonwedged device . No differences in the peak adduction moment during propulsion or peak adduction during stance were observed between the orthotic conditions . A subject-specific laterally wedged orthotic device was able to reduce the peak knee adduction moment during early stance , which is thought to be associated with the progression of knee osteoarthritis . Previous studies on this device have reported issues associated with foot discomfort when using wedge amounts > 7 degrees ; however , no such issues were reported in this study . Therefore , providing a custom laterally wedged orthotic device may potentially increase compliance while still potentially reducing disease progression OBJECTIVE To compare the effectiveness of transcutaneous electrical nerve stimulation ( TENS ) , interferential currents ( IFCs ) , and shortwave diathermy ( SWD ) against each other and sham intervention with exercise training and education as a multimodal package . DESIGN A double-blind , r and omized , controlled , multicenter trial . SETTING Departments of physical medicine and rehabilitation in 4 centers . PARTICIPANTS Patients ( N=203 ) with knee osteoarthritis ( OA ) . INTERVENTIONS The patients were r and omized by the principal center into the following 6 treatment groups : TENS sham , TENS , IFCs sham , IFCs , SWD sham , and SWD . All interventions were applied 5 times a week for 3 weeks . In addition , exercises and an education program were given . The exercises were carried out as part of a home-based training program after 3 weeks ' supervised group exercise . MAIN OUTCOME MEASURES Primary outcome was a visual analog scale ( 0 - 100 mm ) to assess knee pain . Other outcome measures were time to walk a distance of 15 m , range of motion , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , Nottingham Health Profile , and paracetamol intake ( in grams ) . RESULTS We found a significant decrease in all assessment parameters ( P<.05 ) , without a significant difference among the groups except WOMAC stiffness score and range of motion . However , the intake of paracetamol was significantly lower in each treatment group when compared with the sham groups at 3 months ( P<.05 ) . Also , the patients in the IFCs group used a lower amount of paracetamol at 6 months ( P<.05 ) in comparison with the IFCs sham group . CONCLUSIONS Although all groups showed significant improvements , we can suggest that the use of physical therapy agents in knee OA provided additional benefits in improving pain because paracetamol intake was significantly higher in the patients who were treated with 3 sham interventions in addition to exercise and education Background : Knee joint osteoarthritis ( OA ) is one of the most incapacitating diseases affecting older population , which is associated with pain and functional limitation . Various kinds of conservative treatment have been used to decrease knee pain and to improve the quality of life of the subjects suffering from this disease . There are discrepancies in the clinical effects reported for the use of lateral wedge insole in spite of being used as one of the first conservative mechanical treatments for patients with medial compartments of knee OA . Methods : A total of 36 subjects with medial knee compartment OA were recruited in this research project . Subjects were r and omized into two groups to receive 3- and 7-mm lateral wedge insoles based on the date of birth of the participants . Some parameters such as severity of knee pain , Tibiofemoral angle ( TFA ) , severity of OA , and quality of life were selected in this research project . Results : The use of both 3-mm and 7-mm lateral wedge insole improves the quality of life and decreases knee joint pain . However , the effect of 7 mm lateral wedge insole was more than that of 3 mm . Conclusion : Using lateral wedge insole is a simple , inexpensive therapy for decreasing pain and improving quality of life ; however , most research must be carried out to find the effects of lateral wedge on severity of knee joint OA and aligning TFA Background The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation ( TENS ) is more effective than acupuncture or TENS alone for treating knee osteoarthritis ( OA ) . Methods Thirty-two patients with knee OA were r and omly allocated to four groups . The acupuncture group ( ACP ) received only acupuncture treatment at selected acupoints for knee pain ; the TENS group ( TENS ) received only TENS treatment at pain areas ; the acupuncture and TENS group ( A&T ) received both acupuncture and TENS treatments ; the control group ( CT ) received topical poultice ( only when necessary ) . Each group received specific weekly treatment five times during the study . Outcome measures were pain intensity in a visual analogue scale ( VAS ) and knee function in terms of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results The ACP , TENS and A&T groups reported lower VAS and WOMAC scores than the control group . Significant reduction in pain intensity ( P = 0.039 ) and significant improvement in knee function ( P = 0.008 ) were shown in the A&T group . Conclusion Combined acupuncture and TENS treatment was effective in pain relief and knee function improvement for the sample d patients suffering from knee OA Pneumatic unloader bracing with extension assists have been proposed as a non-operative modality that may delay the need for knee surgery by reducing pain and improving function . This prospect i ve , r and omized trial evaluated 52 patients who had knee osteoarthritis for changes in : ( 1 ) muscle strength ; ( 2 ) objective functional improvements ; ( 3 ) ; subjective functional improvements ; ( 4 ) pain ; ( 5 ) quality of life ; and ( 6 ) conversion to total knee arthroplasty ( TKA ) compared to st and ard of care . Patient outcomes were evaluated at a minimum 3 months . Braced patient 's demonstrated significant improvements in muscle strength , several functional tests , and patient reported outcomes when compared to the matched cohort . These results are encouraging and suggest that this device may represent a promising alternative to st and ard treatment methods for knee osteoarthritis The aim of this study was to evaluate the effects of electrical stimulation program on pain , disability , and quadriceps strength in the patients with knee osteoarthritis . Fifty women diagnosed as knee osteoarthritis were r and omized into two groups as electrical stimulation and biofeedback-assisted isometric exercises . Both of the programs were performed 5 days a week , for a duration of 4 weeks . Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index ( WOMAC ) pain score . Disability and stiffness were assessed with WOMAC physical function and stiffness score . One repetition maximum ( RM ) and 10 RM were used for measuring quadriceps strength . In addition , 50 m walking time and 10 steps stairs climbing up-down time were evaluated . Both groups showed significant improvements in pain , physical function , and stiffness scores after the therapy . There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength . In addition , there were no significant differences between the groups after the therapy . We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation ( TENS ) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities . TENS , with a modulated frequency , intensity as high as the subject could tolerate , and electrodes placed on either side and parallel to the incision , was compared to placebo TENS and pharmacologic analgesia alone ( control ) by using a crossover design . Self-report of pain intensity , walking function , and vital capacity were assessed on 33 subjects . TENS result ed in significantly less pain than the control during both walking ( P < .5 ) and vital capacity activities ( P < .1 ) and significantly less pain than placebo TENS during vital capacity ( P < .01 ) . TENS also produced significantly better gait speeds than the control ( P < .05 ) and greater gait distances ( P < .01 ) than the control and placebo TENS . Vital capacity and pain intensity at rest were not significantly different among the 3 treatments . These results suggest TENS reduces pain intensity during walking and deep breathing and increases walking function postoperatively when used as a supplement to pharmacologic analgesia . The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia The purpose of the study was to examine the clinical efficacy of individually prescribed laterally wedged orthoses and walking shoes in the treatment of medial knee osteoarthritis using a prospect i ve , single-blind , block-r and omized controlled design . Sixty-six subjects ( 29 males , 37 females , mean age 62.4 years , mean BMI 33.0 kg/m(2 ) ) were block-r and omized to a lateral wedge ( treatment ) or neutral ( control ) orthotic group . Both groups were issued a Output:

Overall , all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee . This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIM Bracing is considered to be effective in the treatment of adolescent idiopathic scoliosis . The concept prevailing today includes an asymmetrical construction , mainly using a mechanical three-point system . We developed the new Sforzesco brace , based on the SPoRT concept ( Symmetric , Patient-oriented , Rigid , Three-dimensional , active ) . The aim of this study is to verify the results of this concept and brace , compared to three-point classical systems . METHODS We performed a prospect i ve , pair-controlled study . It was possible to match 15 patients , out of the first 18 consecutively treated with the Sforzesco brace ( Group SPoRT ) , with previous patients treated with the Lyon brace ( Group LY ) . SPoRT included 14.2+/-1.7 year old patients , with 47+/-7 degrees Cobb worst curves , and 11+/-4 degrees Bunnell ; LY included 13.6+/-1.6 year old patients , with 43+/-7 degrees Cobb and 12+/-5 degrees Bunnell . The brace had to be worn 23 h per day and patients were evaluated after 6 months both clinical ly and radiographically ( without the brace ) . Appropriate statistics were used . RESULTS At the baseline there were slight differences between the groups , with SPoRT worse than LY . All radiographic and clinical parameters decreased significantly with treatment in both groups , apart from thoracic Cobb degrees in LY . SPoRT had better results than LY ( P<0.05 ) radiographically ( worst curve -10+/-5 degrees vs -5+/-7 degrees , all curves -8+/-7 degrees vs -6+/-7 degrees ) , for sagittal profile ( distance from plumbline : T12 -6+/-9 mm vs + 2+/-8 and L3 -7+/-12 vs 0+/-10 ) and aesthetics of the shoulders ( 9 improved and 6 unchanged vs 5 and 8) and waists ( 10 improved and 5 unchanged vs 5 and 8) . Finally , clinical results in terms of patient recovery were better in SPoRT than LY ( 12 improved and 3 unchanged vs 8 and 5 ) . CONCLUSION When a new treatment is introduced , it is not possible to wait years ( end of therapy ) before verifying its utility , and in scoliosis bracing a short term study already gives very important clues . This study confirms the immediate efficacy of brace treatment ( even in such high degree cases ) whatever the brace concept used , with only 2 ( out of 30 ) progressed curves . In SPoRT we had no progressions , and obtained a statistically significant 80 % better radiographic results than LY in the worst scoliosis curve , and 40 % in the average of all curves , as well as improved aesthetics and sagittal profile ( that is crucial in scoliosis bracing ) . The Sforzesco brace should be used , and the SPoRT concept explored in the long term to verify if the classical three-point system should be totally ( or partially ) ab and oned The purpose of the present study was to investigate the effect of aerobic training in girls with idiopathic scoliosis , in selective respiratory parameters ( VC , FVC , FEV1 , FEV1/VC% FEV1/FVC ) as well as the ability to perform aerobic work ( PWC170 ) . The training group consisted of 20 young girls with a mean age of 13.5 + /- 0.16 years . They wore a Boston-type brace for a mean period of 0.30 + /- 0.04 years and suffered from a scoliotic curve ( 27.4 + /- 1.9 degrees ) . They followed a two-month training program on the cycloergometer . Each training session lasted 30 min and was performed four times a week . The control group consisted of 20 girls with a mean age of 13.6 + /- 0.18 years and they wore the same type of brace for a mean period of 0.24 + /- 0.04 years . They also suffered from a scoliosis ( 29.5 + /- 1.8 degrees ) . The results of the study revealed that aerobic training sustained ( VC , FEV1 , FEV1/VC ) or improved significantly ( FVC , FEV1/FVC ) the parameters of pulmonary function , while the respective parameters ( VC , FVC ) for the control group were reduced during the two-month period . The ability to perform aerobic work increased 48.1 % ( P < 0.01 ) in the training group , while it decreased 9.2 % ( P < 0.01 ) in the control group Background The effectiveness of orthotic treatment continues to be controversial in international medical literature due to differences in the reported results and conclusions of various studies . Heterogeneity of the sample s has been suggested as a reason for conflicting results . Besides the obvious theoretical differences between the brace concepts , the variability in the technical factors can also explain the contradictory results between same brace types . This paper will investigate the degree of variability among responses of scoliosis specialists from the Brace Study Ground of the International Society on Scoliosis Orthopedic and Rehabilitation Treatment SOSORT . Ultimately , this information could be a foundation for establishing a consensus and framework for future prospect i ve controlled studies . Methods A preliminary question naire on the topic of ' brace action ' relative to the theory of three-dimensional scoliosis correction and brace treatment was developed and circulated to specialists interested in the conservative treatment of adolescent idiopathic scoliosis . A particular case was presented ( main thoracic curve with minor lumbar ) . Several key points emerged and were used to develop a second question naire which was discussed and full filed after the SOSORT consensus meeting ( Milano , Italy , January 2005 ) . Results Twenty-one question naires were completed . The Chêneau brace was the most frequently recommended . The importance of the three point system mechanism was stressed . Options about proper pad placement on the thoracic convexity were divided 50 % for the pad reaching or involving the apical vertebra and 50 % for the pad acting caudal to the apical vertebra . There was agreement about the direction of the vector force , 85 % selecting a ' dorso lateral to ventro medial ' direction but about the shape of the pad to produce such a force . Principles related to three-dimensional correction achieved high consensus ( 80%–85 % ) , but suggested methods of correction were quite diverse . Conclusion This study reveals that among participating SOSORT specialists there continues to be a strongly held and conflicting if not a contentious opinion regarding brace design and treatment . If the goal of a ' treatment consensus ' is realistic and achievable , significantly more effort will be required to reconcile these differences UNLABELLED There is low evidence on the possible efficacy of exercises to treat idiopathic scoliosis , grade d as C by the existing Italian Guidelines . Our aim was to verify if exercises quality has an effect on results . DESIGN Prospect i ve controlled study on idiopathic scoliosis patients that performed only exercises to avoid progression . TREATMENT SEAS Group make exercises according to the protocol SEAS.02 ( Scientific Exercises Approach to Scoliosis , version 2002 ) . The CONT Group performed exercises at a local structure according to different protocol s preferred by the treating therapists . Population . SEAS : 48 patients ( 37 females ) , 12.5+/-2.2 years , 15.1 degrees + /-5.7 degrees Cobb ( degrees C ) , 9.0 degrees + /-3.3 degrees Bunnell ( degrees B ) . The difference in the number of braced patients within the first year has been almost statistically significant ( P=0.07 ) : 1 in SEAS vs. 5 in CONT . Cobb degrees improved with treatment ( P<0.05 ) only in the SEAS group . Clinical results ( variation of at least 5 degrees C or 2 degrees B ) were better in SEAS than CONT . Not all exercises for scoliosis have the same efficacy : this study proves the short term efficacy of SEAS.02 when compared to usual care The r and omized controlled trial is often difficult , impractical or unethical in the clinical setting . Specific types of experimental design are examined for application and ease of interpretation of results , with particular focus on the generalization and demonstration of cause and effect . Examples are given of relatively easy changes that greatly strengthen the design and several recently published studies are used as illustrative examples UNLABELLED The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in order to obtain a better reduction of the braced scoliotic curve . Our aim was to verify this hypothesis . DESIGN A prospect i ve controlled study on consecutive patients having idiopathic scoliosis with brace management . OUTCOME Results after 5 months of brace wearing were review ed by radiographic examination without the brace . TREATMENT SEAS Group exercises according to the protocol SEAS.02 ( Scientific Exercises Approach to Scoliosis , version 2002 ) ; CONT Group various type of exercises . Population . 110 patients ( 34 females ) , 13.5+/-2.4 years , 31.1 degrees + /-11.1 degrees Cobb ( degrees C ) , 14.4 degrees + /-6.0 degrees Bunnell ( degrees B ) . All parameters improved at follow-up in both groups . SEAS had better results than CONT for degrees C. Clinical results ( variations of at least 5 degrees C and 2 degrees B ) were better in SEAS than CONT . This study proves the efficacy of SEAS.02 exercises preparatory for bracing . Bracing demonstrated its short term efficacy The goal of this study is to test the hypothesis that physiotherapy-based intervention can reduce incidence of progression in children with IS . Two independent patient groups matched by age and sex at diagnosis were analysed using the outcome parameter , incidence of progression ( S 5 ° ) . One group was untreated and the other received scoliosis in-patient rehabilitation ( SIR ) . Incidence of progression in groups of untreated patients ranged from 1.5-fold ( 71.2 % vs 46.7 % ) to 2.9-fold ( 55.8 % vs 19.2 % ) higher than in groups of patients treated with SIR , even when SIR-treated groups included patients with more severe curvatures . Statistically , the differences were highly significant . Efforts to test the hypothesis that physical therapies addressing postural imbalance can be used effectively in the treatment of IS have been limited . The results of this study are consistent with the possibility that a supervized programme of exercise-based therapies can reduce incidence of progression in children with IS Abstract A group of 44 patients with idiopathic scoliosis ( mean age 13.6 years ) with an initial Cobb angle between 20 ° and 32 ° received side-shift therapy ( mean treatment duration 2.2 years ) . A group of 120 brace patients ( mean age 13.6 years ) with an initial Cobb angle in the same range ( mean brace treatment 3.0 years ) was the historical reference group . Failure was defined as an increase of Cobb angle greater than 5 ° within 4 months or a Cobb angle greater than 35 ° or a total increase of Cobb angle greater than 10 ° . The chance of success was not significantly different between the side-shift and the brace groups , whether tested for efficiency ( 66 % vs 68 % ) or efficacy ( 85 % vs 90 % ) . The difference in the mean progression of the Cobb angle for the respective groups is small ( for efficiency : 3 ° vs –2 ° , for efficacy : 2 ° vs –1 ° ) . Side-shift therapy appears to be a promising additional treatment for idiopathic scoliosis in adolescents with an inital Cobb angle between 20 ° and 32 ° The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis ( AIS ) was investigated . Sixteen ( 16 ) AIS patients with progressing or high-risk curves ( Cobb 's angle between 25 ° and 35 ° at start and reducible by lateral bending ) were fitted with a device with tone alarm for poor posture . In the first 18 months of application , 3 patients defaulted and 4 showed curve progression > 10 ° ( 2 changed to rigid spinal orthoses and 2 underwent surgery ) . The curves for the other 9 patients were kept under control ( within ±5 ° of Cobb 's angle ) and 5 of them have reached skeletal maturity and terminated the application . The remaining 4 patients were still using the devices until skeletal maturity or curve progression . The curve control rate was 69 % . A long-lasting active spinal control could be achieved through the patient 's own spinal muscles . Nevertheless , before the postural training device could become a treatment modality , a long-term study for more AIS patients was necessary . This project is ongoing in the Duchess of Kent Children 's Hospital , S and y Bay , Hong Kong Output:

Apart from one ( no autocorrection , symmetric exercises , very low method ological quality ) , all studies confirmed the efficacy of exercises in reducing the progression rate ( mainly in early puberty ) and /or improving the Cobb angles ( around the end of growth ) . Exercises were also shown to be effective in reducing brace prescription .

MS2_1shot506

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background — Percutaneous coronary interventions in patients with chronic kidney disease have shown suboptimal results . Drug-eluting stents ( DES ) might reduce the rate of target vessel revascularization in comparison with bare-metal stents ( BMS ) in patients with chronic kidney disease . However , given the multiple concomitant individual variables present in such patients , the comparison of neointimal growth after percutaneous coronary intervention is complex and difficult to assess . Methods and Results — R and omized Comparison of Xience V and Multi-Link Vision Coronary Stents in the Same Multivessel Patient with Chronic Kidney Disease ( RENAL-DES ) was a prospect i ve , r and omized , multicenter study to directly compare the efficacy in the prevention of clinical restenosis of everolimus-eluting stent ( Xience V ) and BMS with an identical design ( Multi-Link Vision ) , both implanted in the same patient with multivessel coronary artery disease and chronic kidney disease ( estimated glomerular filtration rate < 60 mL/min ) . The primary end point of the study was the ischemia-driven target vessel revascularization as detected with myocardial scintigraphy at 12 months . In 215 patients , 512 coronary vessels were successfully treated with the r and omly assigned DES ( n=257 ) or BMS ( n=255 ) . At 1 year , the rate of ischemia-driven target vessel revascularization for DES and BMS groups was 2.7 % ( 95 % confidence interval , 1.1%–5.6 % ) and 11.4 % ( 95 % confidence interval , 7.8 % to 16 % ) , respectively , P<0.001 . For the multivariate analysis , independent predictors of the ischemia-driven target vessel revascularization were BMS implantation ( odds ratio , 4.95 ; 95 % confidence interval , 2.1–11.6 ; P<0.001 ) and vessel size ( odds ratio , 0.32 ; 95 % confidence interval , 0.1–0.7 ; P=0.006 ) . Conclusions — This is the first r and omized trial showing a reduction of clinical restenosis with a new-generation DES in comparison with a BMS of equal design , in patients who have chronic kidney disease with multivessel coronary artery disease . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00818792 Background Chronic kidney disease ( CKD ) is strongly associated with adverse outcomes after percutaneous coronary intervention ( PCI ) . There are limited data on the effectiveness of drug-eluting stents ( DES ) in patients with CKD . Methodology /Principal Findings Of 3,752 consecutive patients enrolled in the Guthrie PCI Registry between 2001 and 2006 , 436 patients with CKD - defined as a creatinine clearance < 60 mL/min - were included in this study . Patients who received DES were compared to those who received bare metal stents ( BMS ) . Patients were followed for a mean duration of 3 years after the index PCI to determine the prognostic impact of stent type . Study end-points were all-cause death , myocardial infa rct ion ( MI ) , target vessel revascularization ( TVR ) , stent thrombosis ( ST ) and the composite of major adverse cardiovascular events ( MACE ) , defined as death , MI or TVR . Patients receiving DES in our study , by virtue of physician selection , had more stable coronary artery disease and had lower baseline risk of thrombotic or restenotic events . Kaplan-Meier estimates of proportions of patients reaching the end-points were significantly lower for DES vs. BMS for all-cause death ( p = 0.0008 ) , TVR ( p = 0.029 ) and MACE ( p = 0.0015 ) , but not MI ( p = 0.945 ) or ST ( p = 0.88 ) . Multivariable analysis with propensity adjustment demonstrated that DES implantation was an independent predictor of lower rates of all-cause death ( hazard ratio [ HR ] 0.48 , 95 % confidence interval [ CI ] 0.25–0.92 ) , TVR ( HR 0.50 , 95 % CI 0.27–0.94 ) and MACE ( HR 0.62 , 95 % CI 0.41–0.94 ) . Conclusions In a contemporary PCI registry , selective use of DES in patients with CKD was safe and effective in the long term , with lower risk of all-cause death , TVR and MACE and similar risk of MI and ST as compared with BMS . The mortality benefit may be a result of selection bias and residual confounding , or represent a true finding ; a hypothesis that warrants clarification by r and omized clinical trials Background —An observational study determining the long-term impact of chronic kidney disease ( CKD ) on patients undergoing percutaneous coronary intervention at a tertiary cardiac referral center . CKD is associated with poor in-hospital outcomes after percutaneous coronary intervention , but its effect beyond 1 year , particularly in the drug-eluting stent ( DES ) era , has not been reported . Methods and Results —Baseline creatinine was available for 11 953 patients entered into a prospect i ve registry ( April 2000 to September 2007 ) . Patients were stratified : those with or without at least moderate CKD ( creatinine clearance , < 60 mL/min ) . Follow-up data were obtained through linkage to a provincial registry . Kaplan – Meier analysis was performed . Cox multiple-regression analysis identified independent predictors of late mortality and major adverse cardiac events ( MACE ) and examined the association between DES use and late outcomes in the presence or absence of CKD . CKD was present in 3070 patients ( 25.7 % ) . In-hospital mortality and MACE were significantly increased in CKD ( 3.34 % versus 0.44 % , P<0.001 and 5.73 % versus 2.2 % , P<0.001 ) . Survival and MACE-free survival at 7 years were reduced ( 64.5±1.4 % versus 89.4±0.5 % , P<0.001 ; 44.0±1.4 % versus 63.4±0.8 % , P<0.001 ) . CKD was an independent predictor of late mortality and MACE ( hazard ratio [ HR ] : 2.18 , CI : 1.90 to 2.49 , P<0.0001 ; HR : 1.37 , CI : 1.25 to 1.49 , P<0.0001 ) . DES use was associated with a significant reduction in both ( HR : 0.71 , CI : 0.60 to 0.83 , P<0.0001 ; HR : 0.70 , CI : 0.63 to 0.78 , P<0.0001 ) . In patients with CKD , DES use was associated with reduced revascularization ( HR : 0.68 , CI : 0.53 to 0.88 , P=0.004 ) and reduced MACE ( HR : 0.81 , CI : 0.69 to 0.95 , P=0.011 ) but not reduced mortality ( HR : 0.85 , CI : 0.69 to 1.05 , P=0.1 ) . Conclusion —In a large registry of “ all comers ” for percutaneous coronary intervention , CKD was an independent predictor of adverse late outcomes . DES use may be associated with improved long-term outcomes in this high-risk cohort , but further prospect i ve studies are required BACKGROUND Linkage to the US Renal Data System ( USRDS ) registry commonly is used to identify end-stage renal disease ( ESRD ) cases , or kidney failure treated with dialysis or transplantation , but it underestimates the total burden of kidney failure . This study vali date s a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation . It compares kidney failure risk factors and outcomes using this broader definition with USRDS-identified ESRD risk factors and outcomes . STUDY DESIGN Diagnostic test study with stratified r and om sampling of hospitalizations for chart review . SETTING & PARTICIPANTS Atherosclerosis Risk in Communities Study ( n=11,530 ; chart review , n=546 ) . INDEX TEST USRDS-identified ESRD ; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases , Ninth or Tenth Revision , Clinical Modification ( ICD-9-CM/ICD-10-CM ) code for hospitalization or death . REFERENCE TEST For ESRD , determination of permanent dialysis therapy or transplantation ; for kidney failure , determination of permanent dialysis therapy , transplantation , or estimated glomerular filtration rate < 15 mL/min/1.73 m(2 ) . RESULTS During 13 years ' median follow-up , 508 kidney failure cases were identified , including 173 ( 34.1 % ) from the USRDS registry . ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years , respectively . Other risk-factor associations were similar between ESRD and kidney failure , except diabetes and albuminuria , which were stronger for ESRD . Survivals at 1 and 5 years were 74.0 % and 24.0 % for ESRD and 59.8 % and 31.6 % for kidney failure , respectively . Sensitivity and specificity were 88.0 % and 97.3 % comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review ; for USRDS-identified ESRD , sensitivity and specificity were 94.9 % and 100.0 % . LIMITATIONS Some medical charts were incomplete . CONCLUSIONS A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone , particularly among older adults . Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition AIMS Evaluation of the long-term safety and efficacy of second-generation everolimus-eluting stents ( EES ) versus first-generation sirolimus-eluting stents ( SES ) in acute myocardial infa rct ion ( AMI ) patients . METHODS AND RESULTS Six hundred and twenty-five patients were r and omised ( 2:1 ) to EES or SES in the multicentre XAMI ( XienceV stent vs. Cypher stent in Primary PCI for Acute Myocardial Infa rct ion ) trial . The primary endpoint was cardiac death , non-fatal AMI or any target vessel revascularisation ( TVR ) at one year , with a planned follow-up of three years . At three-year follow-up , the primary endpoint was 8.0 % for EES and 10.5 % for SES ( p=0.30 ) . Cardiac death was low and comparable in both groups ( EES : 2.5 % versus SES : 2.7 % ; p=0.86 ) , as was definite/probable stent thrombosis ( EES : 2.3 % versus SES 3.2 % ; p=0.60 ) . CONCLUSIONS The event rate at three years in this all-comer , r and omised , multicentre AMI trial was low , including stent thrombosis , with no significant difference between first- and second-generation DES . Registration of trial : http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=1123 C and i date number : 2869 ; NTR number : NTR1123 BACKGROUND Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications , yet the benefits and risks of treatment beyond 1 year are uncertain . METHODS Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed . After 12 months of treatment with a thienopyridine drug ( clopidogrel or prasugrel ) and aspirin , patients were r and omly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months ; all patients continued receiving aspirin . The co primary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events ( a composite of death , myocardial infa rct ion , or stroke ) during the period from 12 to 30 months . The primary safety end point was moderate or severe bleeding . RESULTS A total of 9961 patients were r and omly assigned to continue thienopyridine treatment or to receive placebo . Continued treatment with thienopyridine , as compared with placebo , reduced the rates of stent thrombosis ( 0.4 % vs. 1.4 % ; hazard ratio , 0.29 [ 95 % confidence interval { CI } , 0.17 to 0.48 ] ; P<0.001 ) and major adverse cardiovascular and cerebrovascular events ( 4.3 % vs. 5.9 % ; hazard ratio , 0.71 [ 95 % CI , 0.59 to 0.85 ] ; P<0.001 ) . The rate of myocardial inf Output:

The use of DESs significantly improves the above outcomes in CKD patients .

MS2_1shot507

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND / AIM The purpose of the present investigation was to determine the effect of self-performed supragingival plaque removal using either manual ( Crest Complete ) or power ( Braun 3D Plaque Remover ) toothbrushing on supra and subgingival plaque composition . METHODS 47 periodontal maintenance subjects completed this single-blind 6 month longitudinal study . At baseline , sample s of supra and separately subgingival plaque were taken from the mesial aspect of each tooth in each subject using sterile curettes and individually analyzed for their content of 18 bacterial taxa using checkerboard DNA-DNA hybridization . After r and om assignment to groups receiving either a manual ( n=25 ) or power toothbrush ( n=22 ) , subjects received instruction in oral hygiene and used their assigned toothbrush 2x daily for 6 months . Clinical monitoring and microbiological sampling were repeated at 3 and 6 months . Significant differences in microbiological measures over time were sought using the Quade test and between brushing groups at each time point using the Mann-Whitney test . RESULTS Mean total counts were significantly reduced for supra- and subgingival plaque sample s in the manual group and subgingival sample s in the powered brushing group . Actinomyces naeslundii and Actinomyces israelii/gerencseriae were the most numerous organisms detected at baseline and showed the greatest reductions in counts in both brushing groups . Streptococcus constellatus/intermedius was significantly reduced in both groups , while Streptococcus mitis/oralis/sanguis was significantly reduced in the manual toothbrushing group . Mean counts of species were more markedly altered in subgingival plaque . Major reductions occurred in both groups for A. naeslundii , A. israelii/gerencseriae , Peptostreptococcus micros , Veillonella parvula , Prevotella intermedia/nigrescens , S. mitis/oralis/sanguis and S. constellatus/intermedius . All taxa examined were reduced in prevalence ( % of sites colonized ) in the subgingival plaque sample s for both brushing groups . The reductions in prevalence were greater for A. naeslundii , S. constellatus/intermedius , V. parvula , A. israelii/gerencseriae , S. mitis/oralis/sanguis , P. micros , Streptococcus mutans and P. intermedia/nigrescens . Mean prevalence was decreased more for Porphyromonas gingivalis , Campylobacter rectus/showae , Treponema denticola and Bacteroides forsythus in supragingival plaque than subgingival plaque . CONCLUSIONS The major finding was the effect of supragingival plaque removal on the composition of the subgingival microbiota . Counts and prevalence of most taxa examined were markedly decreased in both toothbrushing groups . This reduction should translate to a decreased risk of periodontal disease initiation or recurrence . Further , the decreased prevalence of periodontal pathogens in supragingival plaque lowers potential reservoirs of these species OBJECTIVE To compare the short-term performance of subgingival local delivery of 2 % minocycline gel and conventional subgingival debridement in supportive periodontal therapy ( SPT ) patients . METHODS Forty adult patients having completed active treatment for moderate to advanced chronic periodontitis were included in a r and omized , controlled , single masked maintenance care pilot study . Sites with residual pocket probing depths > or = 5 mm and bleeding on probing were treated with either minocycline gel ( minocycline-group ) or scaling and root planing only ( debridement-group ) at baseline , 3 , 6 , and 9 months . Clinical and microbiological examinations were performed at baseline , 3 , 6 , 9 , and 12 months . RESULTS Full-mouth plaque and bleeding scores remained < 10 % and < 20 % , respectively , for both groups throughout the study . In both groups there was a persistent reduction in number of teeth and sites with probing pocket depths > or = 5 mm ( p<0.05 ) with no significant differences between the groups . The prevalence of Porphyromonas gingivalis , Tannerella forsythia , Treponema denticola , Actinobacillus actinomycetemcomitans , Prevotella intermedia , and Prevotella nigrescens , remained at levels < or = 10(5 ) in the majority of patients and sites in both groups . CONCLUSION This pilot study failed to show a difference between local delivery of 2 % minocycline gel as mono-therapy and traditional subgingival debridement in patients on SPT AIM The objective of this r and omized , controlled clinical trial was to compare the clinical and microbiological effects of pocket debridement using erbium-doped : yttrium , aluminium and garnet ( Er : YAG ) laser with conventional debridement in maintenance patients . MATERIAL & METHODS Fifteen patients , all smokers , having at least four teeth with residual probing depth ( PD ) ≥ 5 mm were recruited . Two pockets in two jaw quadrants were r and omly assigned to subgingival debridement using an Er : YAG laser ( test ) or ultrasonic scaler/curette ( control ) at 3-month intervals . Relative attachment level ( RAL ) , PD , bleeding on probing and dental plaque were recorded at baseline and at 6 and 12 months . Microbiological subgingival sample s were taken at the same time points and analysed using a checkerboard DNA-DNA hybridization technique . RESULTS A significant decrease in PD took place in both treatments from baseline to 12 months ( p < 0.01 ) . In the control , the mean initial PD decreased from 5.4 to 4.0 mm at 12 months . For the test , a similar decrease occurred . No significant between-treatment differences were shown at any time point . The mean RAL showed no overall significant inter- or intra-treatment differences ( p > 0.05 ) . No significant between-treatment differences were observed in subgingival microbiological composition or total pathogens . CONCLUSION The results failed to support that an Er : YAG laser may be superior to conventional debridement in the treatment of smokers with recurring chronic inflammation . This appears to be the first time that repeated Er-YAG laser instrumentation has been compared with mechanical instrumentation of periodontal sites with recurring chronic inflammation over a clinical ly relevant time period Objectives To evaluate repeated subgingival air-polishing in residual pockets with a new erythritol powder containing 0.3 % chlorhexidine . Material and Methods Single-centre , examiner masked , r and omized clinical trial of 12 months with a two-arm , within-subject parallel design . Fifty patients in periodontal maintenance were monitored in 3-month intervals . At months 0 , 3 , 6 and 9 , all sites presenting with a probing depth ( PD ) > 4 mm were subject to subgingival air-polishing ( test side ) or ultrasonic debridement ( control side ) . The primary endpoint was presence/absence of PD > 4 mm after 12 months . Results Totally 6918 sites were monitored at baseline , 457 of them had a PD > 4 mm ( range 5–9 mm ) . The number of pockets > 4 mm per subject , PD and bleeding on probing were significantly lower at month 12 . Differences between test and control were not significant . There was a significant difference in favour of air-polishing for the perception of pain/discomfort . Differences of frequencies at > 1000 and > 100,000 cells/ml of six microorganisms between baseline and month 12 were not significant . At month 12 , test sites were less frequently positive for Aggregatibacter actinomycetemcomitans at > 1000 cells/ml than controls , and counts never exceeded 100,000 cells/ml . Conclusions Repeated subgingival air-polishing reduced the number of pockets > 4 mm similar to ultrasonic debridement . It was safe and induced less pain Recent pre clinical and clinical data have suggested the potential benefit of photodynamic therapy ( PDT ) in the treatment of periodontitis . However , currently , there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis . The aim of the present study was to evaluate the clinical and microbiological effects of the adjunctive use of PDT in non-surgical periodontal treatment in patients receiving supportive periodontal therapy . Twenty-four patients receiving regularly supportive periodontal therapy were r and omly treated with either subgingival scaling and root planing followed by a single episode of PDT ( test ) or subgingival scaling and root planing alone ( control ) . The following parameters were evaluated at baseline and at 3 months and 6 months after therapy : full mouth plaque score ( FMPS ) , full mouth bleeding score ( FMBS ) , bleeding on probing ( BOP ) at experimental sites , probing pocket depth ( PPD ) , gingival recession ( REC ) , and clinical attachment level ( CAL ) . Primary outcome variables were changes in PPD and CAL . Microbiological evaluation of Aggregatibacter actinomycetemcomitans ( A.a . ) , Porphyromonas gingivalis ( P.g . ) , Prevotella intermedia ( P.i . ) , Tannerella forsythensis ( T.f . ) , Treponema denticola ( T.d . ) , Peptostreptococcus micros ( P.m . ) , Fusobacterium nucleatum ( F.n . ) , Campylobacter rectus ( C.r . ) , Eubacterium nodatum ( E.n . ) , Eikenella corrodens ( E.c . ) , and Capnocytophaga species ( C.s . ) was also performed at baseline and at 3 months and 6 months after therapy , using a commercially available polymerase chain reaction test . No differences in any of the investigated parameters were observed at baseline between the two groups . At 3 months and 6 months after treatment , there were no statistically significant differences between the groups in terms of PPD , CAL and FMPS . At 3 months and 6 months , a statistically significantly higher improvement of BOP was found in the test group . At 3 months after therapy , the microbiological analysis showed a statistically significant reduction of F.n . and E.n . in the test group . At 6 months , statistically significantly higher numbers of E.c . and C.s . were detected in the test group . The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PPD reduction and CAL gain , but it result ed in significantly higher reduction of bleeding scores than following scaling and root planing alone BACKGROUND This study assessed the long-term effects of adjunctive antimicrobial therapy on periodontal disease progression and oral colonization . METHODS Patients with previously untreated chronic periodontitis and subgingival Actinobacillus actinomycetemcomitans and /or Porphyromonas gingivalis were r and omly assigned to subgingival scaling without ( control group ) or with systemic amoxicillin plus metronidazole and CHX irrigation ( test group ) . Relative attachment levels were determined and subgingival and mucosal plaque sample s were taken at baseline , at 10 days ( plaque only ) and at 3 , 6 , 9 , 12 , 18 , and 24 months following initial therapy . During maintenance therapy , patients received supragingival debridement only . RESULTS After 24 months , the 18 test group patients showed at sites with initial probing depths ( PD ) > or = 7 mm a significantly ( P < 0.05 ) higher frequency of 2 mm or more attachment gain ( 37.3 % + /- 4.6 % ) and lower frequency of attachment loss ( 7.2 % + /- 3.1 % ) compared to the 17 controls ( 8.2 % + /- 3.9 % and 19.1 % + /- 13.1 % , respectively ) . Compared to controls , the intraoral prevalence of A. actinomycetemcomitans ( up to 18 months ) and P. gingivalis ( up to 3 months ) decreased and that of Eikenella corrodens ( at 10 days ) increased in test patients ( P < 0.05 ) . In both treatment groups , the detection frequency of Tannerella forsythensis decreased transiently , while an overall increase was recorded for Treponema ssp . CONCLUSIONS Over the 24-month period , a single course of the administered adjunctive antimicrobial therapy led to a relative risk reduction of 62 % for attachment loss at deep sites . However , with the exception of A. actinomycetemcomitans , it failed to induce long-term changes in the prevalence profiles of oral colonization The present study evaluated the long-term effect of ( i ) meticulous self-performed , supragingival plaque control and ( ii ) the use of a triclosan/copolymer containing dentifrice in adult subjects susceptible to destructive periodontitis . 40 individuals were recruited into the trial . 3 - 5 years prior to the baseline examination , they had all been treated by nonsurgical means- for advanced periodontal disease . During the subsequent maintenance phase , all subjects had at different time intervals exhibited sites with recurrent periodontitis . At a baseline examination , 6 surfaces per tooth were examined regarding bleeding on probing , probing pocket depth , and probing attachment level . The deepest pocket site in each quadrant ( i.e. 4 sites per subject ) was selected and sample s of the subgingival bacteria were taken . At baseline , all volunteers received detailed information on proper oral hygiene techniques . This information was repeated on an individual need basis during the course of the subsequent 36-months . No professional subgingival therapy was delivered between the baseline and the 36-month examinations . The subjects were r and Output:

The results showed that both SPG and SPG+SBG protocol s of PMP determined stability in the microbiological results along time .

MS2_1shot508

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Six children with cystic fibrosis who had persistently had Pseudomonas aeruginosa isolated from their respiratory tract , completed a double-blind cross-over comparison of oral flucloxacillin and nebulized aminoglycoside versus double placebo . The patients had higher FEV1 results at the end of the month of active treatment than after the month of placebo A r and omized cross-over study was undertaken to compare nebulized ( 1 ) ceftazidime with ( 2 ) a combination of gentamicin and carbenicillin , and ( 3 ) saline , each given for 4 months , in patients with cystic fibrosis infected with Pseudomonas aeruginosa . Mean peak expiratory flow on ceftazidime , 299 litres/min , and on gentamicin and carbenicillin , 297 litres/min , were greater than on saline , 278 litres/min ( P less than 0.02 and P less than 0.05 respectively ) . Similarly mean forced expiratory volume in 1 second on ceftazidime , 1.70 litres , and on gentamicin and carbenicillin , 1.70 litres , were greater than on saline , 1.48 litres ( P less than 0.02 and P less than 0.01 respectively ) . Mean forced vital capacity on gentamicin and carbenicillin , 2.93 litres , was also greater than on saline ( P less than 0.05 ) . We were unable to demonstrate any difference in efficacy between the antibiotic regimens . The patients were admitted to hospital less frequently during the study year compared with the previous year ( P less than 0.05 ) . Sixty-nine per cent of patients had a clinical ly significant ( 20 % ) increase in forced expiratory volume in 1 second on an antibiotic regimen compared with that on entry to study , but a minority of patients appear not to respond to this form of treatment Aminoglycoside-resistance mechanisms were characterized in Pseudomonas aeruginosa isolates from cystic fibrosis ( CF ) patients during a recent clinical trial of inhaled tobramycin . Impermeability , in which bacteria have reduced susceptibility to all aminoglycosides , was the predominant mode of resistance in isolates obtained both before and after 6 months of cyclic treatment with tobramycin or placebo administered by aerosol . Enzymatic resistance mechanisms were found in fewer than 10 % of resistant isolates . P. aeruginosa from individual patients could be grouped on the basis of genetic relatedness . When enzymatic resistance was involved , all isolates in a group had elevated tobramycin MICs . When impermeability occurred , MICs of a genotypic group varied from susceptible to resistant . These findings suggest that impermeability resistance occurs in only a fraction of the P. aeruginosa population in lungs of persons with CF and that this form of resistance arises by a process involving multiple small changes in MIC STUDY OBJECTIVE To determine the effect of long-term suppression of Pseudomonas aeruginosa on lung function and other clinical end points in adolescent patients with cystic fibrosis ( CF ) . DESIGN Two identical , r and omized , placebo-controlled trials followed by three open-label follow-on trials . SETTING Sixty-nine CF study centers in the United States . INTERVENTIONS Active drug consisting of a 300-mg tobramycin solution for inhalation ( TSI ) . PATIENTS One hundred twenty-eight adolescent CF patients ( aged 13 to 17 years ) with P aeruginosa and mild-to-moderate lung disease ( FEV(1 ) percent predicted > or = 25 % and < or = 75 % ) . MEASUREMENTS Pulmonary function , P aeruginosa colony forming unit density , incidence of hospitalization and IV antibiotic use , weight gain , and aminoglycoside toxicity were monitored . RESULTS At the end of the first three 28-day cycles of TSI treatment , patients originally r and omized to TSI and placebo treatments exhibited improvements in FEV(1 ) percent predicted of 13.5 % and 9.4 % , respectively . FEV(1 ) percent predicted was maintained above the value at initiation of TSI treatment in both groups . At the end of the last " on-drug " period ( 92 weeks ) , patients originally r and omized to TSI and placebo treatments showed improvements of 14.3 % and 1.8 % , respectively . Improvement in pulmonary function was significantly correlated with reduction in P aeruginosa colony forming unit density ( p = 0.0001 ) . The average number of hospitalizations and IV antibiotic courses did not increase over time . TSI treatment was associated with increased weight gain and body mass index . P aeruginosa susceptibility to tobramycin decreased slightly over time , but this was not correlated with clinical response . CONCLUSIONS TSI treatment improved pulmonary function and weight gain in adolescent patients with CF over a 2-year period of long-term , intermittent use The major cause of morbidity and mortality in patients with cystic fibrosis ( CF ) is respiratory disease ( Penketh et al. , Thorax 1987 ; 42 : 526 - 532 ) . Recent studies in the USA have shown that intermittent administration of inhaled tobramycin is beneficial to patients with CF who are chronically infected with Pseudomonas aeruginosa ( Ramsey et al. , N Engl J Med 1999 ; 340 : 23 - 30 ; Ramsey et al. , Proceedings of the 12th Annual North American Cystic Fibrosis Conference , 1998 , Montreal , Canada ; Ramsey et al. , Abstract from 23rd European Cystic Fibrosis Conference , 1999 , the Hague , Netherl and s ) . In Europe , the use of nebulised colistin in patients chronically infected with P. aeruginosa is widespread . A recently published study compared the efficacy and safety of tobramycin nebuliser solution ( TNS ) and nebulised colistin in CF patients . One hundred and fifteen patients were r and omised to receive either TNS or colistin in a multi-centre open-labelled study that assessed change from baseline in FEV(1 ) and sputum P. aeruginosa density . TNS produced a mean 6.7 % improvement in lung function ( P=0.006 ) , whilst there was no significant improvement in the colistin-treated patients . The TNS-treated patients had a significantly greater improvement in lung function than those treated with colistin ( P=0.008 ) . The safety profile of both treatments was good . We conclude that patients treated with TNS for 1 month experience improved lung function compared with patients treated with colistin Chronic infection with Pseudomonas aeruginosa is associated with progressive deterioration in lung function in cystic fibrosis ( CF ) patients . The purpose of this trial was to assess the efficacy and safety of tobramycin nebuliser solution ( TNS ) and nebulised colistin in CF patients chronically infected with P. aeruginosa . One-hundred and fifteen patients , aged ≥6 yrs , were r and omised to receive either TNS or colistin , twice daily for 4 weeks . The primary end point was an evaluation of the relative change in lung function from baseline , as measured by forced expiratory volume in one second % predicted . Secondary end points included changes in sputum P. aeruginosa density , tobramycin/colistin minimum inhibitory concentrations and safety assessment s. TNS produced a mean 6.7 % improvement in lung function ( p=0.006 ) , whilst there was no significant improvement in the colistin-treated patients ( mean change 0.37 % ) . Both nebulised antibiotic regimens produced a significant decrease in the sputum P. aeruginosa density , and there was no development of highly resistant strains over the course of the study . The safety profile for both nebulised antibiotics was good . Tobramycin nebuliser solution significantly improved lung function of patients with cystic fibrosis chronically infected with Pseudomonas aeruginosa , but colistin did not , in this study of 1-month 's duration . Both treatments reduced the bacterial load OBJECTIVES This r and omized , double-blind , cross-over study evaluated the risk of bronchoconstriction with two preparations of inhaled tobramycin in children with cystic fibrosis ( CF ) infected with Pseudomonas aeruginosa with and without airway hyperreactivity . DESIGN Of 19 children with CF ( age range , 7 to 16 years ) with mild-to-moderate pulmonary disease , 10 children were at high risk ( HR ) for bronchospasm ( family history of asthma and previous response to bronchodilators ) and 9 children were at low risk ( LR ) for bronchospasm ( no family history of asthma or previous response to bronchodilators ) . Two solutions of tobramycin were administered : ( 1 ) 80 mg in a 2-mL vial diluted with 2 mL of saline solution containing the preservatives phenol and bisulfites ( IV preparation ) ; and ( 2 ) 300 mg in a preservative-free preparation in a 5-mL solution . Following a bronchodilator-free period of 12 h , the patients inhaled either one or the other preparation in r and om order on two different occasions , 2 weeks apart . RESULTS Prechallenge and postchallenge results for the LR group showed a percentage of fall in FEV(1 ) ( DeltaFEV(1 ) ) of 12 + /- 9 % ( mean + /- SD ) for the IV preparation , compared to 4 + /- 5 % for the preservative-free preparation ( p = 0.046 ) . An DeltaFEV(1 ) of > 10 % was seen in six of nine patients for the IV preparation and in one of nine patients for preservative-free preparation . For the HR group , the DeltaFEV(1 ) was 17 + /- 13 % for the IV-preparation group , compared to 16 + /- 12 % for the preservative-free group ( p = 0.4 ) . In this group , equal numbers of patients ( 8 of 10 patients ) had an DeltaFEV(1 ) > 10 % after inhaling each preparation . The largest DeltaFEV(1 ) was 44 % ( HR group with the preservative-free preparation that forced the early termination of inhalation ) . CONCLUSIONS Both preparations caused significant bronchoconstriction in the HR group , and the preservative-containing IV preparation caused more bronchospasm in LR group than the preservative-free solution . Heightened airway reactivity in children with CF places them at risk of bronchospasm from inhalation therapy In chronic Pseudomonas aeruginosa pulmonary infection of patients with cystic fibrosis ( CF ) , antibiotic therapy generally fails to eradicate the bacterial pathogen . The mucoid bacterial phenotype , high sputum production by the host , and low airway levels of antibiotics seem to be responsible for the observed decrease in antibiotic efficacy . We hypothesized that early antibiotic treatment by inhalation in CF patients may be able to prevent or at least delay airway infection . In a prospect i ve placebo-controlled , double-blind , r and omized multicenter study , 22 CF patients received either 80 mg b.i.d . of aerosolized tobramycin or placebo for a period of 12 months shortly after the onset of P. aeruginosa pulmonary colonization . Two patients in the tobramycin and six patients in the placebo group stopped inhalation before the 12 month treatment period . Using life table analysis , the time to conversion from a P. aeruginosa-positive to a P. aeruginosa-negative respiratory culture was significantly shorter in the tobramycin-treated group than in the placebo group ( P < 0.05 , log rank test ) . Lung function parameters and markers of inflammation did not change in either group during treatment . The results of this study suggest that early tobramycin inhalation may prevent and /or delay P. aeruginosa pulmonary infection in CF patients BACKGROUND Inhalation of hypertonic nebulised colistin causes chest tightness and is a reason for discontinuing the treatment . This study examines the relationship of chest tightness and change in lung function in response to the inhalation of a range of tonicities of nebulised colistin and their influence on patients ' preference . METHODS Twenty seven adult patients with cystic fibrosis and a mean forced expiratory volume in one second ( FEV1 ) of 54 % predicted ( range 24 - 98 ) were studied . They inhaled a nebulised solution of hypertonic , isotonic , and hypotonic colistin over three consecutive days in r and om order in a double blind fashion . Measurements of chest tightness , using a visual analogue scale ( VAS ) , and FEV1 were recorded before and 0 , 15 , 30 , 60 , and 90 minutes following inhalation . The solution preferred by each patient was determined at the end of the three days . RESULTS All tonicities caused a significant fall in FEV1 % predicted and an increase in chest tightness , with no differences between the solutions . However , the mean ( SE ) time to the maximum fall in FEV1 % predicted was significantly different between the solutions ( hypertonic 7.8 ( 2.1 ) min , isotonic 19.2 ( 5.5 ) min , and hypotonic 34.2 ( 5.9 ) min ) with a mean difference ( 95 % CI ) between hypotonic and hypertonic solutions of 28.04 ( 14.6 to 41.5 ) min , between isotonic and hypertonic solutions of 12.0 ( -0.1 to 24.1 ) min , and between hypotonic and isotonic solutions of 15.6 ( 1.8 to 29 Output:

Lung function measured as forced expired volume in one second ( FEV1 ) was generally better in the treated groups than in control groups but a pooled estimate of effect was not possible . Resistance to antibiotic increased more in the antibiotic treated group than in placebo group . REVIEW ER 'S CONCLUSIONS Nebulised anti-pseudomonal antibiotic treatment improves lung function and reduces frequency of exacerbations of infection in people with cystic fibrosis .

MS2_1shot509

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: UVB phototherapy of atopic dermatitis was investigated in two paired‐comparison studies . In study 1 , 17 patients were treated for 8 weeks with ultraviolet B radiation ( UVB ) on one half of the body and with visible light ( placebo ) on the other . A severity score based on eight clinical variables was determined before , during and after treatment . The total score , pruritus score and overall evaluation score were significantly better on the UVB treated sides than on the placebo treated sides ( P < 0.001 ) . In 13 patients the UVB treated side healed or improved considerably , while the placebo treated side improved considerably in one patient only In a paired-comparison study 30 patients with atopic dermatitis underwent treatment with a combination of UVA and UVB radiation ( UVAB ) on one side of the body and UVB on the other . Treatment was administered three times a week for a maximum of 8 weeks . Each patient was evaluated with respect to eight effect variables . Statistically significant differences in favor of UVAB were observed for all analyzed variables , namely total score ( p = 0.002 ) , pruritus score ( p = 0.04 ) , and overall evaluation score ( p = 0.03 ) . No statistically significant differences in healing rate were seen ; 25 of 30 UVB-treated , and 26 of 30 UVAB-treated , body halves healed or were considerably improved . Patient preference was overwhelmingly in favor of UVAB ; 23 of 24 patients who completed an evaluation form preferred this treatment . Only 1 of 24 preferred UVB BACKGROUND Besides glucocorticosteroids , there is currently no known effective therapy for patients with acute atopic dermatitis . OBJECTIVE The therapeutic effectiveness of high-dose UVA1 irradiation in the management of patients with acute exacerbation of atopic dermatitis was examined . METHODS Patients in the high-dose UVA1 group ( n = 15 ) were irradiated with 130 joules/cm2 UVA1 ; the control group ( n = 10 ) was treated with UVA-UVB therapy in a minimal erythema dose-dependent manner ( total number of treatments 15 ) . RESULTS High-dose UVA1 irradiation was found to induce a significant clinical improvement of atopic dermatitis ( p less than 0.001 ) . In comparison with UVA-UVB therapy , significant differences in favor of high-dose UVA1 were observed ( p less than 0.01 ) . High-dose UVA1 , but not UVA-UVB treatment , significantly reduced the elevated serum level of eosinophil cationic protein in patients with atopic dermatitis ( p less than 0.003 ) . CONCLUSION These studies indicate that high-dose UVA1 irradiation may represent a novel phototherapeutic modality for the treatment of patients with an acute exacerbation of atopic dermatitis Two paired-comparison left-right studies were conducted with patients suffering from atopic dermatitis . In study 1 , 18 patients were treated with low-dose ultraviolet B ( UVB ) radiation on one body-half and with combined UVA and UVB ( UVAB ) on the other 3 times a week for up to 8 weeks . Eight effect variables were recorded . Statistically significant differences in favor of UVAB were seen for 3 variables analyzed , total score , overall evaluation score and pruritus score . The healing score was likewise better with UVAB ; 17 patients achieved healing or considerable improvement as compared with 5 patients with UVB treatment . The result was judged to be better with UVAB in 16 subjects and equal in 2 . In none of the cases did low-dose UVB yield better results . Sixteen patients preferred UVAB to UVB , 2 had no preference , but none preferred low-dose UVB . In study 2 , the arms or legs of 25 patients were treated with UVA and UVAB , respectively , 5 days a week for 3 weeks . UVAB proved to be better when comparing total score and overall evaluation score . No difference in pruritus score was detected . The healing score favored UVAB . Twenty-three patients healed or improved considerably with UVAB as compared with 17 patients with UVA . Better results were achieved with UVAB in 15 patients , with UVA in 4 , and both therapies yielded equal results in 6 cases . Eighteen patients preferred UVAB , 5 UVA and 2 neither . Both UVA and UVAB yielded scores superior to untreated control patches BACKGROUND Narrow-b and ultraviolet B ( UVB ) is an effective treatment for psoriasis , and open studies suggest that this phototherapy might improve atopic eczema . We did a r and omised controlled trial to compare narrow-b and UVB , UVA , and visible light phototherapy as second-line , adjunctive treatments in adult patients with moderate to severe atopic eczema . METHODS Phototherapy was administered twice a week for 12 weeks . 26 patients were r and omly assigned narrow-b and UVB , 24 were assigned UVA , and 23 visible fluorescent light . The primary endpoints were change in total disease activity ( sum of scores at six body sites ) and change in extent of disease after 24 treatments compared with baseline . Data were analysed by the method of summary measures . FINDINGS 13 patients withdrew or were excluded from analysis . Mean reductions in total disease activity over 24 treatments in patients who received narrow-b and UVB and UVA , respectively , were 9.4 points ( 95 % CI 3.6 to 15.2 ) and 4.4 points ( -1.0 to 9.8 ) more than in patients who received visible light . Mean reductions in extent of disease after 24 treatments with narrow-b and UVB and UVA were 6.7 % ( 1.5 to 11.9 ) and -1.0 % ( -5.3 to 3.3 ) compared with visible light . A small proportion of patients developed erythema after phototherapy or had a flare in their eczema sufficient to withdraw from treatment . INTERPRETATION Narrow-b and UVB is an effective adjunctive treatment for moderate to severe atopic eczema , and the treatment is well tolerated by most patients BACKGROUND Data from an uncontrolled trial suggest synchronous balneophototherapy ( sBPT ) , which simulates treatment conditions at the Dead Sea , to be effective in the management of atopic dermatitis ( AD ) . OBJECTIVES The purpose of this prospect i ve r and omized controlled study was to compare the efficacy and safety of sBPT with narrow-b and ( NB ) UVB monotherapy ( PT ) for AD . METHODS In this phase III multicentre trial , 180 patients with moderate-to-severe AD were allocated to two groups in a 1:1 ratio ; group 1 received sBPT consisting of NB UVB treatment and synchronous bathing in 10 % Dead Sea salt solution , group 2 monotherapy with UVB 311 nm . The confirmatory study design consisted of up to 35 treatment sessions . Primary endpoint , analysed on an intention-to-treat-basis ( n=169 ) , was the relative improvement of the severity SCORing of the Atopic Dermatitis Index ( SCORAD ) from baseline to the end of treatment ( 35 sessions or early cure ) . Sample -size calculation aim ed at establishing at least 15 % superiority . RESULTS SCORing of the Atopic Dermatitis Index at baseline was comparable between sBPT ( 61.8±14.1 ) and PT ( 61.5±12.4 ) group . At the end of therapy , a clinical ly relevant and statistically significant difference of 26.2 % could be shown ( P<0.001 ) . Exploratory testing showed statistically significant superiority of sBPT after 6 months . Mild adverse events more frequently occurred in the sBPT group ( n=46 , PT : n=31 ) , whereas more patients withdrew early because of adverse events in the PT group ( n=6 , sBPT : n=2 ) . CONCLUSIONS A clear advantage of sBPT in comparison to PT was proven . Tolerability was comparable ; both treatments showed to be safe BACKGROUND Several studies have demonstrated the efficacy of UVA1 ( 340 - 400 nm ) phototherapy for patients with severe atopic dermatitis . However , the optimum treatment dose has yet to be determined . Although in seminal investigations high UVA1 doses were used , comparable results were reported in recent studies with a medium-dose regimen . OBJECTIVE Our purpose was to compare the efficacy of high-dose with medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis . METHODS Ten adult patients with a median baseline SCORAD score of 67 were enrolled in an investigator-blinded , bilateral comparison study . Treatment was given 5 times weekly over a period of 3 weeks on an outpatient basis . Irradiation was performed by exposing one half of the patient 's body to high-dose UVA1 ( < or = 130 J/cm(2 ) ) , and the contralateral body side received only half that dose . The clinical response was assessed after 5 , 10 , and 15 treatments . After completion of the study , patients were followed up for 6 months to evaluate the duration of clinical improvement . RESULTS All but one patient responded favorably to treatment . High-dose UVA1 led to a decrease of the median SCORAD score by 33.4 % after 1 week , 38.4 % after 2 weeks , and 34.7 % after 3 weeks . The respective values for the medium-dose regimen were 29.7 % , 36.4 % , and 28.2 % . The difference in efficacy between the two dosages remained below the level of significance at all time points . Relapses occurred after a median of 4 weeks . Time of onset and severity of relapse were the same for both doses . CONCLUSION Our data support previous uncontrolled observations that medium-dose UVA1 is comparably as effective as high-dose treatment for patients with severe generalized atopic dermatitis . Irrespective of the dose regimen , follow-up examinations revealed early relapse in the majority of patients BACKGROUND Phototherapy may be effective in atopic dermatitis ( AD ) . Medium-dose ( MD ) ultraviolet ( UV ) A1 was introduced for the treatment of AD . Few immunohistochemical data are available pertaining to phototherapy in AD . Regulatory T cells may play a role in clearing AD . OBJECTIVES We sought to compare the clinical and immunohistochemical effects of narrowb and ( NB ) UVB and MD UVA1 treatment in patients with AD . METHODS Thirteen adult patients with AD were included in this r and omized investigator-blinded half-sided comparison study between NB UVB and MD UVA1 . Disease activity was measured using the Leicester sign score . Skin biopsy specimens were taken before and after phototherapy . Regulatory T cells were stained with the forkhead box protein P3 ( FoxP3 ) . RESULTS NB UVB and MD UVA1 both significantly decreased AD severity ( P < .01 ) and the dermal cellular infiltrate . The percentage of FoxP3(+)CD3(+ ) T cells did not change after NB UVB or MD UVA1 treatment . LIMITATION MD UVA1 therapy was given 3 times per week instead of the preferred regimen of 5 times per week . This was necessary to achieve good blinding of the study . CONCLUSIONS NB UVB and MD UVA1 seem equally effective in the treatment of patients with moderate to severe AD . Neither MD UVA1 nor NB UVB had an effect on the percentage of FoxP3(+)CD3(+ ) T cells Summary In a paired‐comparison study , 21 patients suffering from atopic dermatitis were treated with fluorescent tubes radiating mainly ultraviolet A ( UVA ) on one half of the body and with tubes radiating mainly UVB on the other . Treatment was given three times a week for up to 8 weeks . Eight variables reflecting disease status were recorded and the sum of these comprised the total score . The total score and the overall evaluation score were better with UVA therapy ( p<0·02 and P=0·01 , respectively . No statistically significant difference for the pruritus score was found . The reduction in extent of dermatitis , seen with both therapies , was more pronounced with UVA ( P<0·05 ) . Differences in the healing score were not statistically significant . Treatment with UVA result ed in healing or considerable improvement in 15 patients and 13 patients showed improvement when treated with UBA . A better result was found with UVA in 10 subjects and with UVB in two subjects . Equal results occurred with both UVA and UVB in nine of the patients although most preferred UVA treatment BACKGROUND The results of an open , single-center study suggested that phototherapy with high doses of UVA1 radiation ( UVA1R ; 340 - 400 nm ) is effective for acute , severe exacerbations of atopic dermatitis ( AD ) . OBJECTIVE The purpose of this study was to assess the effectiveness of high-dose UVA1 phototherapy for acute , severe AD in a r and omized multicenter trial in direct comparison with topical glucocorticoid therapy . METHODS Patients were treated with high-dose UVA1R ( 10 days , 130 J/cm2/day ; n = 20 ) , topically with fluocortolone ( 10 days , 1 x daily ; n = 17 ) , or with UVA-UVB therapy ( 10 days , 1 x daily , minimal erythema dose-dependent ; n = 16 ) . RESULTS With a clinical scoring system , significant differences in favor of high-dose UVA1R and fluocortolone therapy were observed Output:

There is evidence for the use of narrow-b and UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis . Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood .

MS2_1shot510

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : The correlation between noninvasive markers with endoscopic activity according to the modified Baron Index in patients with ulcerative colitis ( UC ) is unknown . We aim ed to evaluate the correlation between endoscopic activity and fecal calprotectin ( FC ) , C-reactive protein ( CRP ) , hemoglobin , platelets , blood leukocytes , and the Lichtiger Index ( clinical score ) . Methods : UC patients undergoing complete colonoscopy were prospect ively enrolled and scored clinical ly and endoscopically . Sample s from feces and blood were analyzed in UC patients and controls . Results : We enrolled 228 UC patients and 52 healthy controls . Endoscopic disease activity correlated best with FC ( Spearman 's rank correlation coefficient r = 0.821 ) , followed by the Lichtiger Index ( r = 0.682 ) , CRP ( r = 0.556 ) , platelets ( r = 0.488 ) , blood leukocytes ( r = 0.401 ) , and hemoglobin ( r = −0.388 ) . FC was the only marker that could discriminate between different grade s of endoscopic activity ( grade 0 , 16 [ 10–30 ] & mgr;g/g ; grade 1 , 35 [ 25–48 ] & mgr;g/g ; grade 2 , 102 [ 44–159 ] & mgr;g/g ; grade 3 , 235 [ 176–319 ] & mgr;g/g ; grade 4 , 611 [ 406–868 ] & mgr;g/g ; P < 0.001 for discriminating the different grade s ) . FC with a cutoff of 57 & mgr;g/g had a sensitivity of 91 % and a specificity of 90 % to detect endoscopically active disease ( modified Baron Index ≥2 ) . Conclusions : FC correlated better with endoscopic disease activity than clinical activity , CRP , platelets , hemoglobin , and blood leukocytes . The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients OBJECTIVES : Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn 's disease ( SES-CD ) and noninvasive markers are scarce . The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin , C-reactive protein ( CRP ) , blood leukocytes , and the Crohn 's disease activity index ( CDAI ) . METHODS : Crohn 's disease patients undergoing complete ileocolonoscopy were prospect ively enrolled and scored independently according to the SES-CD and the CDAI . SES-CD was defined as follows : inactive 0–3 ; mild 4–10 ; moderate 11–19 ; and high ≥20 . RESULTS : Values in CD patients ( n=140 ileocolonoscopies ) compared with controls ( n=43 ) are as follows : calprotectin , 334±322 vs. 18±5 μg/g ; CRP , 26±29 vs. 3±2 mg/l ; and blood leukocytes , 9.1±3.4 vs. 5.4±1.9 g/l ( all P<0.001 ) . The SES-CD correlated closest with calprotectin ( Spearman 's rank correlation coefficient r=0.75 ) , followed by CRP ( r=0.53 ) , blood leukocytes ( r=0.42 ) , and the CDAI ( r=0.38 ) . Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity ( 104±138 vs. 231±244 μg/g , P<0.001 ) , mild from moderate activity ( 231±244 vs. 395±256 μg/g , P=0.008 ) , and moderate from high activity ( 395±256 vs. 718±320 μg/g , P<0.001 ) . The overall accuracy for the detection of endoscopically active disease was 87 % for calprotectin ( cutoff 70 μg/g ) , 66 % for elevated CRP , 54 % for blood leukocytosis , and 40 % for the CDAI ≥150 . CONCLUSIONS : Fecal calprotectin correlated closest with SES-CD , followed by CRP , blood leukocytes , and the CDAI . Furthermore , fecal calprotectin was the only marker that reliably discriminated inactive from mild , moderate , and highly active disease , which underlines its usefulness for activity monitoring OBJECTIVES : There are limited data on the yield of colonoscopy in patients with irritable bowel syndrome ( IBS ) . This study compared the prevalence of structural colonic lesions in patients with suspected non-constipation-predominant IBS and healthy volunteers . We also determined the yield of rectosigmoid biopsies in patients with suspected IBS . METHODS : This was a prospect i ve , case – control study conducted at three US sites . Patients with suspected non-constipation-predominant IBS ( Rome II ) underwent colonoscopy with rectosigmoid biopsies . Healthy persons undergoing colonoscopy for colorectal cancer screening or polyp surveillance comprised the control group . Abnormalities identified at colonoscopy were compared between suspected IBS and control groups . RESULTS : In all , 466 suspected IBS patients and 451 controls were enrolled . Suspected IBS patients were significantly younger ( P<0.0001 ) and more frequently female ( P<0.0001 ) than controls . The most common lesions in suspected IBS patients were hemorrhoids ( 18.2 % ) , polyps ( 14.6 % ) , and diverticulosis ( 8.8 % ) . Suspected IBS patients had a lower prevalence of adenomas ( 7.7 % vs. 26.1 % , P<0.0001 ) and diverticulosis ( 8.8 % vs. 21.3 % , P<0.0001 ) and higher prevalence of mucosal erythema or ulceration ( 4.9 % vs. 1.8 % , P<0.01 ) compared with controls . Logistic regression found the between-group differences in adenoma prevalence to be robust after correction for demographic factors . The overall prevalence of microscopic colitis in suspected IBS patients was 1.5 % ( 7/466 ) and 2.3 % ( 4/171 ) in those ≥45 years of age . CONCLUSIONS : The prevalence of structural abnormalities of the colon is no higher in suspected non-constipation IBS patients than in healthy controls . Microscopic colitis can be identified in a small proportion of persons with IBS symptoms Background : Symptoms of inflammatory bowel disease ( IBD ) and irritable bowel syndrome ( IBS ) can overlap . We aim ed to determine the accuracy of fecal markers , C‐reactive protein ( CRP ) , blood leukocytes , and antibody panels for discriminating IBD from IBS and to define a “ best test . ” Methods : We prospect ively included 64 patients with IBD ( 36 Crohn 's disease [ CD ] , 28 ulcerative colitis [ UC ] ) , 30 with IBS , and 42 healthy controls . Besides CRP and blood leukocytes , blinded fecal sample s were measured for calprotectin ( PhiCal Test , enzyme‐linked immunosorbent assay [ ELISA ] ) , lactoferrin ( IBD‐SCAN , ELISA ) , Hexagon‐OBTI ( immunochromatographic test for detection of human hemoglobin ) , and LEUKO‐TEST ( lactoferrin latex‐agglutination test ) . Blinded serum sample s were measured for the antibodies ASCA ( ELISA ) and pANCA ( immunofluorescence ) . Results : Overall accuracy of tests for discriminating IBD from IBS : IBD‐SCAN 90 % , PhiCal Test 89 % , LEUKO‐TEST 78 % , Hexagon‐OBTI 74 % , CRP 73 % , blood leukocytes 63 % , CD antibodies ( ASCA+/pANCA− or ASCA+/pANCA+ ) 55 % , UC antibodies ( pANCA+/ASCA− ) 49 % . ASCA and pANCA had an accuracy of 78 % for detecting CD and 75 % for detecting UC , respectively . The overall accuracy of IBD‐SCAN and PhiCal Test combined with ASCA/pANCA for discriminating IBD from IBS was 92 % and 91 % , respectively . Conclusions : The PhiCal Test and IBD‐SCAN are highly accurate for discriminating IBD from IBS . There is only marginal additional diagnostic accuracy when the PhiCal Test and IBD‐SCAN are combined with ASCA and pANCA . ASCA and pANCA have a high specificity for IBD Backgound : Patients being investigated for symptoms of abdominal pain , diarrhoea and or weight loss often undergo small bowel radiology as part of their diagnostic workup mainly to exclude inflammatory bowel disease Prospect i ve measurements were made of serum C-reactive protein levels and erythrocyte sedimentation rate in sixty-four patients with Crohn 's disease and fifty with ulcerative colitis . The results were related to clinical assessment of disease activity . C-reactive protein levels were raised in both groups but were significantly higher in Crohn 's disease than ulcerative colitis for all categories of disease severity : with mild disease the median and range of C-reactive protein concentration were 4 , 0 - 65 mg/l in Crohn 's disease v. 0 , 0 - 15 mg/l in ulcerative colitis , P less than 0.01 ; in moderate disease the values were 15 , 1 - 100 mg/l v. 3 , 0 - 29 mg/l respectively , P less than 0.05 and in cases of severe disease , 85 , 15 - 183 mg/l v. 12 , 2 - 33 mg/l respectively , P less than 0.001 . Erythrocyte sedimentation rate was also higher in Crohn 's disease but did not closely reflect disease activity in individual patients . C-reactive protein levels corresponded closely with clinical and pathological indices of relapse , remission and response to therapy in patients with Crohn 's disease . The precise assay of serum C-reactive protein provides an objective criterion of inflammatory activity , which may be useful in the assessment , management and study of Crohn 's disease BACKGROUND AND AIMS Assessing the presence and degree of intestinal inflammation objective ly , simply , and reliably is a significant problem in gastroenterology . We assessed faecal excretion of calprotectin , a stable neutrophil specific marker , as an index of intestinal inflammation and its potential use as a screening test to discriminate between patients with Crohn 's disease and those with irritable bowel syndrome . METHODS The validity of faecal calprotectin as a marker of intestinal inflammation was assessed in 22 patients with Crohn 's disease ( 35 studies ) by comparing faecal excretions and concentrations using four day faecal excretion of111indium white cells . A cross sectional study assessed the sensitivity of faecal calprotectin concentration for the detection of established Crohn 's disease ( n=116 ) . A prospect i ve study assessed the value of faecal calprotectin in discriminating between patients with Crohn 's disease and irritable bowel syndrome in 220 patients referred to a gastroenterology clinic . RESULTS Four day faecal excretion of 111indium ( median 8.7 % ; 95 % confidence interval ( CI ) 7–17 % ; normal < 1.0 % ) correlated significantly ( p<0.0001 ) with daily ( median ranged from 39 to 47 mg ; normal <3 mg ; r=0.76–0.82 ) and four day faecal calprotectin excretion ( median 101 mg ; 95 % CI 45–168 mg ; normal < 11 mg ; r=0.80 ) and single stool calprotectin concentrations ( median 118 mg/l ; 95 % CI 36–175 mg/l ; normal < 10 mg/l ; r=0.70 ) in patients with Crohn 's disease . The cross sectional study showed a sensitivity of 96 % for calprotectin in discriminating between normal subjects ( 2 mg/l ; 95 % CI 2–3 mg/l ) and those with Crohn 's disease ( 91 mg/l ; 95 % CI 59–105 mg/l ) . With a cut off point of 30 mg/l faecal calprotectin has 100 % sensitivity and 97 % specificity in discriminating between active Crohn 's disease and irritable bowel syndrome . CONCLUSION The calprotectin method may be a useful adjuvant for discriminating between patients with Crohn 's disease and irritable bowel syndrome Purpose This study was design ed to evaluate the accuracy of four different fecal markers in discriminating between irritable bowel syndrome , inflammatory bowel disease , and other forms of colitis and to examine the feasibility of collecting fecal sample s in out patients . Methods We prospect ively included 20 Output:

None of the biomarkers reliably distinguished between IBS and healthy controls . Individual analysis of ESR and lactoferrin had little clinical utility . Conclusion : CRP and calprotectin of ≤0.5 or 40 , respectively , essentially excludes IBD in patients with IBS symptoms . The addition of CRP and calprotectin to symptom-based criteria may improve the confident diagnosis of IBS

MS2_1shot511

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: INTRODUCTION The cost-effectiveness of blood cultures in community-acquired pneumonia ( CAP ) has been question ed . Although penicillin-resistant Streptococcus pneumoniae is an increasing problem , penicillin therapy , where appropriate , reduces cost and may reduce antibiotic resistance . Blood cultures , however , can only reduce cost if physicians are prepared to alter therapy based on the results . We review ed our experience to determine how often physicians changed management based on blood culture results positive for S pneumoniae . METHODS Retrospective chart review was performed of all CAP admissions between January 1996 and December 1998 with blood culture results positive for S pneumoniae . RESULTS Seventy-four patients out of 1,805 patients admitted with CAP during this period had pneumococcemia . Penicillin resistance was identified in 15 cases ( 20.3 % ; high grade in 4 cases ) with cephalosporin resistance in 4 of these cases ( 1 high grade ) . Fifty-one patients had initial empiric therapy with a third-generation cephalosporin , and 58 patients had empiric coverage of atypical organisms ; no patient received empiric penicillin therapy . Blood culture results altered management in 31 patients ( 41.9 % ) , but in only 2 cases was this due to antibiotic resistance . Fifty-one patients without penicillin allergy grew penicillin-sensitive pneumococci ; only 11 patients ( 21.6 % ) were changed to penicillin therapy . Thirteen of 35 patients ( 37.1 % ) who were given an additional antibiotic for atypical coverage had this antibiotic ceased . CONCLUSION Despite evidence of penicillin-sensitive pneumococcal CAP , physicians were reluctant to narrow antibiotic therapy , potentially adding to treatment cost and reducing the impact of blood culture results on management . The impact of penicillin resistance was reduced by the usual empiric choice of a third-generation cephalosporin . While positive blood culture results can clearly be useful in the management of patients with CAP , their cost-effectiveness needs to be assessed in prospect i ve clinical trials STUDY OBJECTIVE Although it is considered st and ard of care to obtain blood cultures on patients hospitalized for pneumonia , several studies have question ed the utility and cost-effectiveness of this practice . The objective of this study is to determine the impact of emergency department ( ED ) blood cultures on antimicrobial therapy for patients with pneumonia . METHODS We performed a prospect i ve , observational , cohort study of consecutive adult ( age > or = 18 years ) patients treated at an urban university ED between February 1 , 2000 and February 1 , 2001 . Inclusion criteria were radiographic evidence of pneumonia , clinical evidence of pneumonia , and blood culture obtained . Blood cultures were classified as positive , negative , or contaminant based on previously established criteria . Additionally , data were collected on antimicrobial sensitivities , empiric antibiotic therapy , antibiotic changes , and reasons for changes . RESULTS There were 3,926 ED visits with blood cultures obtained for any reason , of which 3,762 ( 96 % ) were available for review . Of these , 414 of 3,762 ( 11 % ) patients met pneumonia study inclusion criteria , and blood cultures identified 29 of 414 ( 7.0 % ) patients with true bacteremia . In the 414 patients , blood culture results altered therapy for 15 patients ( 3.6 % ) with suspected pneumonia , of which 11 ( 2.7 % ) patients had their coverage narrowed ; only 4 ( 1.0 % ) patients had their coverage broadened because of resistance to empiric therapy . For the 11 patients with bacteremia whose therapy was not altered , culture results actually supported narrowing therapy in 8 ( 1.9 % ) cases , but this was not done . CONCLUSION Blood cultures rarely altered therapy for patients presenting to the ED with pneumonia . More discriminatory blood culture use may potentially reduce re source utilization BACKGROUND Penicillin-resistant strains of Streptococcus pneumoniae are now found worldwide , and strains with resistance to cephalosporin are being reported . The appropriate antibiotic therapy for pneumococcal pneumonia due to resistant strains remains controversial . METHODS To examine the effect of resistance to penicillin and cephalosporin on mortality , we conducted a 10-year , prospect i ve study in Barcelona of 504 adults with culture-proved pneumococcal pneumonia . RESULTS Among the 504 patients , 145 ( 29 percent ) had penicillin-resistant strains of S. pneumoniae ( minimal inhibitory concentration [ MIC ] of penicillin G , 0.12 to 4.0 micrograms per milliliter ) , and 31 patients ( 6 percent ) had cephalosporin-resistant strains ( MIC of ceftriaxone or cefotaxime , 1.0 to 4.0 micrograms per milliliter ) . Mortality was 38 percent in patients with penicillin-resistant strains , as compared with 24 percent in patients with penicillin-sensitive strains ( P = 0.001 ) . However , after the exclusion of patients with polymicrobial pneumonia and adjustment for other predictors of mortality , the odds ratio for mortality in patients with penicillin-resistant strains was 1.0 ( 95 percent confidence interval , 0.5 to 1.9 ; P = 0.84 ) . Among patients treated with penicillin G or ampicillin , the mortality was 25 percent in the 24 with penicillin-resistant strains and 19 percent in the 126 with penicillin-sensitive strains ( P = 0.51 ) . Among patients treated with ceftriaxone or cefotaxime , the mortality was 22 percent in the 59 with penicillin-resistant strains and 25 percent in the 127 with penicillin-sensitive strains ( P = 0.64 ) The frequency of resistance to cephalosporin increased from 2 percent in 1984 - 1988 to 9 percent in 1989 - 1993 ( P = 0.002 ) . Mortality was 26 percent in patients with cephalosporin-resistant S. pneumoniae and 28 percent in patients with susceptible organisms ( P = 0.89 ) . Among patients treated with ceftriaxone or cefotaxime , mortality was 22 percent in the 18 with cephalosporin-resistant strains and 24 percent in the 168 with cephalosporin-sensitive organisms ( P = 0.64 ) . CONCLUSIONS Current levels of resistance to penicillin and cephalosporin by S. pneumoniae are not associated with increased mortality in patients with pneumococcal pneumonia . Hence , these antibiotics remain the therapy of choice for this disease Objectives Although blood cultures are commonly ordered in the emergency department , there is controversy about their utility . This study aim ed to determine the usefulness of blood cultures in the management of patients presenting to a tertiary adult teaching hospital emergency department in Perth , Western Australia . Methods A detailed chart review was undertaken of all blood cultures taken in our emergency department over a 2-month period . All patients within the hospital having blood cultures taken were identified ; from this group , blood cultures originating from the emergency department were review ed . Data were collected concerning patient demographics , culture indication , vital signs , culture outcome , disposition and alterations in management result ing from the blood culture . Results 218 blood cultures were ordered from the emergency department during the study period . This represented 4.0 % ( 218/5478 ) of the total number of patients seen . Of the 218 cultures , only 30 were positive ( 13 % of the study population ) , with 16 ( 7.3 % ) probable contaminants and 14 ( 6.4 % ) true positives . No anaerobic isolates were identified . Of the 14 significantly positive blood cultures , the result influenced management in six patients , result ing in a useful culture rate of 2.8 % ( 6/218 ) . Conclusion Blood cultures are ordered on a significant number of patients seen in the emergency department but rarely alter management . Our findings in conjunction with other studies suggest that eliminating blood cultures in immunocompetent patients with common illnesses such as urinary tract infection , community acquired pneumonia and cellulitis , may significantly reduce the number of blood cultures , producing substantial savings without jeopardizing patient care . This needs prospect i ve study and validation BACKGROUND Since the last British study of the microbial aetiology of community acquired pneumonia ( CAP ) about 20 years ago , new organisms have been identified ( for example , Chlamydia pneumoniae ) , new antibiotics introduced , and fresh advances made in microbiological techniques . Pathogens implicated in CAP in adults admitted to hospital in the UK using modern and traditional microbiological investigations are described . METHODS Adults aged 16 years and over admitted to a teaching hospital with CAP over a 12 month period from 4 October 1998 were prospect ively studied . Sample s of blood , sputum , and urine were collected for microbiological testing by st and ard culture techniques and new serological and urine antigen detection methods . RESULTS Of 309 patients admitted with CAP , 267 fulfilled the study criteria ; 135 ( 50.6 % ) were men and the mean ( SD ) age was 65.4 ( 19.6 ) years . Aetiological agents were identified from 199 ( 75 % ) patients ( one pathogen in 124 ( 46 % ) , two in 53 ( 20 % ) , and three or more in 22 ( 8 % ) ) : Streptococcus pneumoniae 129 ( 48 % ) , influenza A virus 50 ( 19 % ) , Chlamydia pneumoniae 35 ( 13 % ) , Haemophilus influenzae 20 ( 7 % ) , Mycoplasma pneumoniae 9 ( 3 % ) , Legionella pneumophilia 9 ( 3 % ) , other Chlamydiaspp 7 ( 2 % ) , Moraxella catarrhalis 5 ( 2 % ) , Coxiella burnetii 2 ( 0.7 % ) , others 8 ( 3 % ) . Atypical pathogens were less common in patients aged 75 years and over than in younger patients ( 16 % v27 % ; OR 0.5 , 95 % CI 0.3 to 0.9 ) . The 30 day mortality was 14.9 % . Mortality risk could be stratified by the presence of four “ core ” adverse features . Three of 60 patients ( 5 % ) infected with an atypical pathogen died . CONCLUSION S pneumoniae remains the most important pathogen to cover by initial antibiotic therapy in adults of all ages admitted to hospital with CAP . Atypical pathogens are more common in younger patients . They should also be covered in all patients with severe pneumonia and younger patients with non-severe infection BACKGROUND Prompt antibiotic administration , oxygenation measurement , and blood cultures are generally considered markers of high- quality care in the inpatient management of community-acquired pneumonia ( CAP ) . However , few studies have examined the relationship between prompt achievement of process-of-care markers and outcomes for patients with CAP . We examined whether antibiotic administration within 8 hours of hospital arrival , a blood culture within 24 hours , an oxygenation measurement within 24 hours , or performing blood cultures before giving antibiotics was associated with the following : ( 1 ) reaching clinical stability within 48 hours of hospital admission , ( 2 ) a decreased length of hospital stay , or ( 3 ) fewer inpatient deaths . METHODS A retrospective medical record review identified 1062 eligible patients discharged from the hospital with a diagnosis of CAP between December 1 , 1997 , and February 28 , 1998 , among 38 US academic hospitals . We assessed the independent relationship between each process marker and the 3 clinical outcomes , controlling for the Pneumonia Severity Index on admission . We also examined the relationship of pneumonia severity on admission to process marker achievement and clinical outcomes . RESULTS Overall , there was no consistent or statistically significant relationship between achieving process markers and better clinical outcomes ( P>.40 for all ) . We did observe that performing blood cultures within 24 hours was related to not achieving clinical stability within 48 hours ( odds ratio , 1.62 ; 95 % confidence interval , 1.13 - 2.33 ) . However , this finding likely reflects residual confounding by severity of illness , since increasing pneumonia severity on admission was associated with blood culture performance ( P = .009 ) and with shorter times to antibiotic administration ( P = .04 ) . CONCLUSIONS Achieving process-of-care markers was not associated with improved outcomes , but was related to the severity of pneumonia as assessed on admission . Our results highlight the difficulty in demonstrating a link between process-of-care markers and outcomes in observational studies of CAP . R and omized studies are needed to objective ly evaluate the impact of process-of-care markers on CAP outcomes To assess the association between inclusion of a macrolide in a beta-lactam-based empirical antibiotic regimen and mortality among patients with bacteremic pneumococcal pneumonia , 10 years of data from a data base were analyzed . The total available set of putative prognostic factors was subjected to stepwise logistic regression , with in-hospital death as the dependent variable . Of the 409 patients analyzed , 238 ( 58 % ) received a beta-lactam plus Output:

BCs have very limited utility in immunocompetent patients hospitalized with CAP .

MS2_1shot512

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : Dysmenorrhea is a common gynecologic disorder affecting as many as 60 % of menstruating women . In the United States , work absenteeism due to dysmenorrhea is estimated to be 600 million work hours per year , and the economic consequences are estimated at $ 2 billion per year ; therefore , it is a public problem nowadays . Aim : The purpose of this study was to compare the effects of combination of fennel extract/vitamin E with ibuprofen on the intensity of pain in primary dysmenorrhea among the students of Tabriz city in 2007 - 2009 . Material s and Methods : This study was done by using double-blinded quasi-experimental research method . After taking the required licenses from ethics committee , 68 students from Medical and Tabriz universities , who were living in the dormitory , suffering from primary dysmenorrhea , and were eligible for the study , were r and omly divided into two groups of 34 students each ( the two groups used combination of fennel extract/vitamin E and ibuprofen cross-over form in the 2 months ) . We used Visual Analogue Scale ( VAS ) tool for ranking the intensity of the pain . Data analysis was done by using SPSS Ver . 14 . Results : The mean of peak pain intensity in the first , second , third , sixth , and forty-eighth hours in the group that had used combination of fennel extract/vitamin E was lower than the group that had used ibuprofen , and statistical differences were observed between the two groups in the first and second hours ; combination of fennel extract/vitamin E was more effective than ibuprofen in the first hour ( P < 0.03 ) and second hour ( P < 0.04 ) . Conclusion : Combination of fennel extract/vitamin E is effective on decreasing the intensity of pain of primary dysmenorrhea , and it is advised to those who can not use chemical drugs Background Zingiber officinale R. rhizome ( ginger ) is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases . The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea . Method This was a r and omized , controlled trial . The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea . The students were all residents of the dormitories of Shahed University . They were r and omly assigned into two equal groups , one for ginger and the other for placebo in two different treatment protocol s with monthly intervals . The ginger and placebo groups in both protocol s received 500 mg capsules of ginger root powder or placebo three times a day . In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period . In the second protocol ginger and placebo were given only for the first three days of the menstrual period . Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale . Results There was no difference in the baseline characteristics of the two groups ( placebo n = 46 , ginger n = 56 ) . The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one ( P = 0.015 ) and protocol two ( P = 0.029 ) . There was also significant difference in duration of pain between the two groups for protocol one ( P = 0.017 ) but not for protocol two ( P = 0.210 ) . Conclusion Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically significant effect on relieving intensity and duration of pain . Trial registration I RCT OBJECTIVE To evaluate the impact of valerian-a herb with sedative effects and antispasmodic effects on smooth muscles-on the severity of dysmenorrhea . METHODS In a double-blind , r and omized , placebo-controlled trial , 100 students were r and omly assigned to receive valerian ( n=49 ) or placebo ( n=51 ) . Valerian ( dose 255 mg ) was given 3 times daily for 3 days beginning at the onset of menstruation , for 2 consecutive menstrual cycles . At baseline and during the intervention cycles , the pain severity was evaluated with a visual analog scale and the systemic manifestations were assessed using a multidimensional verbal scale . RESULTS The pain severity at baseline did not differ significantly between the groups . After the intervention , the pain severity was significantly reduced in both groups ( P<0.001 ) , but the extent of the reduction was larger in the valerian group , with the difference between the 2 groups being statistically significant ( P<0.05 ) . The total scores of the systemic manifestations associated with dysmenorrhea decreased after the intervention , but there was no significant difference between the groups , with the exception for syncope ( P<0.05 ) . CONCLUSION Valerian seems to be an effective treatment for dysmenorrhea , probably because of its antispasmodic effects Background : Dysmenorrhea has negative effects on women 's life . Due to side-effects of chemical drugs , there is growing trend toward herbal medicine . The aim of this study was to assess the effect of Dill compared to mefenamic acid on primary dysmenorrhea . Material s and Methods : This double-blind , r and omized , clinical trial study was conducted on 75 single female students between 18 and 28 years old educating in Nursing and Midwifery School and Paramedical Faculty of Qom University of Medical Sciences of Iran in 2011 . They were allocated r and omly into one of the three groups : In Dill group , they took 1000 mg of Dill powder q12h for 5 days from 2 days before the beginning of menstruation for two cycles . Other groups received 250 mg mefenamic acid or 500 mg starch capsule as placebo , respectively . Dysmenorrhea severity was determined by a verbal multidimensional scoring system and a visual analog scale ( VAS ) . Students with mild dysmenorrhea were excluded . Data were analyzed by SPSS using the descriptive statistic , paired- sample s t-test , Wilcoxon signed-rank test , Mann-Whitney test , and Kruskal-Wallis test . Results : There were no significant differences between three groups for demographic or descriptive variables . Comprising the VAS showed that the participants of Dill and mefenamic acid groups had lower significant pain in the 1st and the 2nd months after treatment , whereas in the placebo group this was only significant in the 2nd month ( P < 0.05 ) . Conclusion : Dill was as effective as mefenamic acid in reducing the pain severity in primary dysmenorrhea . Further studies regarding side-effects of Dill and its interactivity are recommended OBJECTIVE Wujijing Oral Liquid ( WJJ ) contained principally the flesh essence of the black-boned chicken . As a kind of food and medicine in China , it was used to treat the menstrual disturbance traditionally , but the exact mechanism of the action was not yet clear . The clinical effects of the WJJ on the symptoms of the menstrual disturbance and the reproductive hormones were studied in this paper . MATERIAL S AND METHODS The 53 women with the menstrual disturbance were selected as the study object , and then they were r and omly divided to receive either WJJ 10mL twice daily ( n=28 ) or the placebo ( n=25 ) from the 1st day after menstrual flow for 2 menstrual cycles . On the 1st day after the discontinuation of the medication but before the treatment , the scores for the menstrual pattern and the related symptoms were obtained and the blood sample s were collected to test the reproductive hormones . The serum levels of the follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LH ) , prolactin ( PRL ) and estradiol ( E2 ) were examined by enzyme-linked immunosorbent assay ( ELISA ) . The levels of progesterone ( P ) and testosterone ( T ) in serum were measured by the radioimmunoassay . RESULTS The score for the primary and related symptoms of the menstruation was increased significantly among patients treated with the WJJ . The differences on the FSH , PRL , and E2 levels of patients were significant before and after the treatment with WJJ . Comparing the WJJ group and the placebo group , the levels of P and T differed significantly after treatment . The oral liquid of WJJ was found to be safe , as it did not cause any change in the hepatic and renal functional parameters . CONCLUSION The oral liquid of Wujijing could improve the menstrual disturbance and were generally safe and well tolerated . The possible mechanism could be associated with its effects in reinforcing the kidney and regulating the hypothalamus-pituitary-ovary axis ( HPOA ) Our objective was to examine the effect of an Iranian herbal drug in the treatment of primary dysmenorrhea . A r and omized , double-blind , placebo-controlled pilot trial among 180 female students at Isfahan University dormitory aged 18 to 27 who suffered from primary dysmenorrhea was undertaken . The participants were r and omly divided into three groups : herbal drug , mefenamic acid , and placebo . The herbal drug group was given 500 mg of highly purified saffron , celery seed , and anise ( SCA ) extracts three times a day for three days , starting from the onset of bleeding or pain . Participants were followed for two to three cycles from the beginning of menstruation through the three days of bleeding . Main outcome measures were the severity and duration of pain at 2 and 3 months . A visual analogue scale was used to record pain . There were statistically significant reductions in pain scores and pain duration scores in the groups that took SCA ( P < . 001 ) and mefenamic acid ( P < . 01 ) . The decrease in pain score was reflected by a significant reduction in other drug use among the treatment groups compared with the women in the placebo group . The magnitude of the reduction was significantly greater in the SCA group than in the mefenamic acid and placebo groups . Both drugs effectively relieved menstrual pain as compared with the placebo . More clinical trials are needed to establish the efficacy of this herbal drug Objective Preliminary evaluation of efficacy and safety of uzara use in treatment of moderate and severe primary dysmenorrhea in comparison to ibuprofen . Material s and Methods This r and omized , comparative two way cross-over study comprised 60 single female students at Faculty of Medicine , Ain Shams University , Egypt , aged 19–28 years with moderate ( n = 46 ) or severe ( n = 14 ) primary dysmenorrhea . Participants were r and omized to take either uzara ( 80 mg/8 hours for two doses , then 40 mg/8 hours ) then ibuprofen ( 400 mg/6 hours ) in two subsequent cycles or vice versa . The pain intensity , using VAS , was recorded immediately before taking the medication ( 0 hour ) and after 4 , 12 , 24 , 48–60 , 96–120 hours . Main outcome measures included effectiveness of pain relief defined as drop of VAS to 3 or less , patient 's global evaluation of the drug , absence from school , the use of a rescue medication , and , in those who continued the treatment , the pain intensity difference ( PID ) at different points after start of medication and its sum ( SPID ) . Results Uzara was comparably effective to ibuprofen ( 78.3 % vs. 86.7 % of cycles ; respectively ) , with comparable rates of effectiveness on global evaluation ( being around 50 % for either drug ) , and rates of school absences ( 11.7 % vs. 13.3 % ; respectively ) . The need for rescue medication was different ( 18.3 % and 10 % ; respectively ) , albeit with no statistical significance . The means of PID at different time points and SPID were comparable , with significantly lower average mean of VAS scores compared to that felt with no medication ( 1.6 vs. 6.8 , p<0.001 ) . Side effects were less with uzara than ibuprofen ( 0 % vs. 8.3 % , p<0.05 ) . Conclusions Uzara might be as effective as ibuprofen in management of primary dysmenorrhea but with less side effects . These findings need to be confirmed by a properly design ed trial with a larger sample size . Trial Registration Current Controlled Trials IS RCT Background : Primary dysmenorrhea refers to the occurrence of painful menstrual cramps of uterus and is considered as a gynecological complaint . The common treatment for this problem is medical therapy such as mefenamic acid [ non-steroidal anti-inflammatory drugs ( NSAIDs ) ] and oral contraceptive pills , both of which work by reducing myometrial activity . Fennel contains an antispasmodic and anethol agents and may be helpful for management of primary dysmenorrhea . Material and Methods : The aim of this study was to evaluate the effects of oral fennel drop for treating primary dysmenorrhea . Sixty college students suffering from primary dysmenorrhea were r and omly assigned to two groups and followed up for two cycles . Statistical analysis was performed using SPSS version 16 . P < 0.05 was considered to be statistically significant . Parametric and non-parametric tests were adopted . Results : Comparison of pain intensity in the two groups showed that there was no significant difference in pain relief between the two groups . Comparison of bleeding severity in the study group before and after intervention was demonstrated from the first day to the fifth day ( PV on first day , second day , third day , fourth day , and fifth day 0.948 , 0.330 , 0.508 , 0.583 , 0.890 , respectively ) . Conclusion : It seems that fennel can be effective in reducing the severity of dysmenorrhea , but it Output:

Effectiveness of supplements for secondary dysmenorrhoea There was no strong evidence of benefit for melatonin compared to placebo for dysmenorrhoea secondary to endometriosis ( data were unsuitable for analysis ) . There was no evidence of a difference between the groups but data were too scanty to reach any conclusions about safety . There is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhoea , and evidence of safety is lacking .

MS2_1shot513

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Soil-transmitted helminths ( STHs ) infect over one billion people worldwide . There is concern that chronic infection with STHs among school-aged children may detrimentally affect their development , including their health , cognition , and education . However , two recent Cochrane review s examining the impact of deworming drugs for STH on nutrition , hemoglobin , and school performance found that r and omized controlled trials ( RCTs ) in the literature provide an insufficient evidence base to draw reliable conclusions . This study uses a cluster- RCT to add to existing evidence by assessing the impact of a deworming intervention on nutrition , cognition , and school performance among schoolchildren in rural China . The intervention , implemented by local health practitioners in a setting with a baseline infection prevalence of 41.9 % ( 95 % confidence interval [ CI ] = 39.8 % , 43.9 % ) and infection intensity of 599.5 eggs per gram of feces among positive-tested schoolchildren ( 95 % CI = 473.2 , 725.8 ) , consisted of distributing a 400-mg dose of albendazole accompanied with educational training about STH infection , treatment , and prevention . The intervention was conducted twice over the course of the study -at baseline in May 2013 and later in November 2013 . We found that the deworming intervention reduced both infection prevalence and infection intensity , but these declines in infection were not accompanied by an impact on outcomes of nutrition , cognition , or school performance . Our interpretation is that the impact of deworming was attenuated by the light infection intensity in our sample population . Evidence from future RCTs is needed to assess the effect of deworming on key outcomes in areas with moderate and severe worm infections Abstract Background : Documents from advocacy and fund-raising organizations for child mass deworming programmes in low- and middle-income countries cite unpublished economic studies cl aim ing long-term effects on health , schooling and economic development . Methods : To summarize and appraise these studies , we search ed for and included all long-term follow-up studies based on cluster-r and omized trials included in a 2015 Cochrane review on deworming . We used Cochrane methods to assess risk of bias , and appraised the credibility of the main findings . Where necessary we contacted study authors for clarifications . Results : We identified three studies ( Baird 2016 , Ozier 2016 and Croke 2014 ) evaluating effects more than 9 years after cluster-r and omized trials in Kenya and Ug and a. Baird and Croke evaluate short additional exposures to deworming programmes in setting s where all children were dewormed multiple times . Ozier evaluates potential spin-off effects to infants living in areas with school-based deworming . None of the studies used pre-planned protocol s nor blinded the analysis to treatment allocation . Baird 2016 has been presented online in six iterations . The work is at high risk of reporting bias and selective reporting , and there are substantive changes between versions . The main cited effects on secondary school attendance and job sector allocation are from post hoc subgroup analyses , which the study was not powered to assess . The study did not find any evidence of effect on nutritional status , cognitive tests or school grade s achieved , but these are not reported in the abstract s. Ozier 2016 has been presented online in four iterations , without substantive differences between versions . Higher cognitive test scores were associated with deworming , but the appropriate analysis was underpowered to reliably detect these effects . The size of the stated effect seems inconsistent with the short and indirect nature of the exposure to deworming , and a causal pathway for this effect is unclear . Croke 2014 uses a data set unrelated to the base trial , to report improvements in English and maths test scores . The analysis is at high risk of attrition bias , due to loss of clusters , and is substantially underpowered to assess these effects . Conclusions : In the context of reliable epidemiological methods , all three studies are at risk of substantial method ological bias . They therefore help in generating hypotheses , but should not be considered to provide reliable evidence of effects Abstract Objective : To measure the effects of iron supplementation and anthelmintic treatment on iron status , anaemia , growth , morbidity , and development of children aged 6–59 months . Design : Double blind , placebo controlled r and omised factorial trial of iron supplementation and anthelmintic treatment . Setting : Community in Pemba Isl and , Zanzibar . Participants : 614 preschool children aged 6–59 months . Main outcome measures : Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups . Results : Before intervention , anaemia was prevalent and severe , and geohelminth infections were prevalent and light — Plasmodium falciparum infection was nearly universal . Iron supplementation significantly improved iron status , but not haemoglobin status . Iron supplementation improved language development by 0.8 ( 95 % confidence interval 0.2 to 1.4 ) points on the 20 point scale . Iron supplementation also improved motor development , but this effect was modified by baseline haemoglobin concentrations ( P=0.015 for interaction term ) and was apparent only in children with baseline haemoglobin concentrations < 90 g/l . In children with a baseline haemoglobin concentration of 68 g/l ( one st and ard deviation below the mean value ) , iron treatment increased scores by 1.1 ( 0.1 to 2.1 ) points on the 18 point motor scale . Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura , but not by hookworms . Mebendazole increased development scores by 0.4 ( −0.3 to 1.1 ) points on the motor scale and 0.3 ( −0.3 to 0.9 ) points on the language scale . Conclusions : Iron supplementation improved motor and language development of preschool children in rural Africa . The effects of iron on motor development were limited to children with more severe anaemia ( baseline haemoglobin concentration < 90 g/l ) . Mebendazole had a positive effect on motor and language development , but this was not statistically significant . What is already known on this topic Iron is needed for development and functioning of the human brain Anaemic children show developmental delays , but it is not yet clear whether iron deficiency causes these deficits or whether iron supplementation can reverse them Helminth infections in schoolchildren are associated with cognitive deficits , but few studies have been made of helminth infection and early child development What this study adds Low doses of oral iron supplementation given daily improved language development in children aged 1–4 years in Zanzibar Iron supplementation improved motor development , but only in children with initial haemoglobin concentrations below 90 g/l The effects of routine anthelmintic treatment on motor and language milestones were positive , but non-significant , with our sample Objective : The study was conducted to assess the effectiveness of six monthly albendazole ( ABZ ) for improving the weight and height of preschool children when initia ted at 0.5–1 year of age in population s with a high transmission rate of intestinal roundworm , Ascaris lumbricoides . It was a cluster r and omized trial in the urban slums of Lucknow , North India . Methods : Control children received 2 ml ( 1 ml to infants ) of Vitamin A every six month whereas those in the ABZ areas received , in addition , 400 mg of ABZ suspension ( Zentel , SKB ) every six month . Sixty-three and sixty-one slum areas were r and omized to albendazole ( ABZ ) or to control groups , respectively . Children aged 0.5–1 year were recruited in April 1996 and followed up for 1.5 years . Of 1022 children recruited from control and 988 from ABZ areas , the loss to follow-up at 1.5 year was 15.6 % and 14.6 % respectively . Mean ( ±SE ) weight gain in Kg in control versus ABZ areas was 3.04 ( 0.03 ) versus 3.22 ( 0.03 ) , ( p=0.01 ) . Results : After controlling for the presence of weight-for age z-score < -2.00 at enrollment in the ordinary least square ’s regression model , the extra weight gain in 1.5 years in those who received ABZ plus vitamin A was 0.13 Kg ( 95 % Cl:0.004 to 0.26 Kg . , p value=0.043 ) when compared to those who received only vitamin A ; underweight children at enrollment benefiting more than the normal ones . Conclusion : It was concluded that there was an improvement in weight with six monthly ABZ over 1.5 years . However , a much larger trial would be needed to determine whether there is any net effect of improvement in weight on under five mortality rate The study examines the effect of moderate to high worm burdens of Trichuris trichiura infection on the cognitive functions of 159 school children ( age 9–12 years ) in Jamaica , using a double-blind placebo-controlled protocol . Results were evaluated by using a forward-stepwise multiple linear regression . Removal of worms led to a significant improvement in tests of auditory short-term memory ( p < 0.017 ; p < 0.013 ) , and scanning and retrieval of long-term memory ( p < 0.001 ) . Nine weeks after treatment , there were no longer significant differences between the treated children and an uninfected Control group in these three tests of cognitive function . It is concluded that whipworm infection has an adverse effect on certain cognitive functions which is reversible by therapy The effects of mild to moderate infections of Trichuris trichiura on cognitive functions were investigated in Jamaican children aged 7 to 10 years . In all , 189 infected children and 100 uninfected classmates were studied . The infected children were r and omly assigned to receive treatment ( albendazole ) or a placebo . All children were given cognitive tests on enrolment and 14 weeks later . These included verbal fluency ( generation of ideas ) , digit span ( working memory ) , number choice ( speed of processing of visual stimuli ) , visual search ( sustained attention ) and a French Vocabulary test ( paired-associate learning ) . At baseline , the infected children had lower scores than the uninfected ones in fluency ( P = 0.01 ) , search ( P = 0.02 ) and French ( P = 0.01 ) . Treatment effects were examined among infected children and there was no significant treatment effect for any of the tests . However , there was a significant treatment by weight-for-age interaction in fluency ( P < 0.05 ) . The children with low weight-for-age ( Z-score < -1 ) improved with treatment while there was no improvement with treatment among the other children . We concluded that treatment of children with mild to moderate T. trichiura infections using albendazole produces little benefit in cognition if they are adequately nourished ; however , undernourished children are more likely to benefit OBJECTIVE To determine the prevalence and intensity of intestinal helminth species among school children in southern Ug and a. DESIGN A cross-sectional survey using a r and omly selected sample . SETTING Eighteen districts of southern Ug and a. SUBJECT Two thous and and four school children aged two to twenty years ( 93.3 % , aged 5 - 10 years ) selected from classes 1 and 2 in 26 r and omly selected primary schools . RESULTS Overall , 55.9 % of children were infected with either hookworm , Ascanis lumbricoides or Trichuris trichiura . The prevalence of A. lumbricoides was 17.5 % ( range 0 - 66.7 % by school ) , T. trichiura was 7.3 % ( 0 - 45.0 % ) and hookworm 44.5 % ( 15.6 - 86.0 % ) . The prevalence of A. lumbricoides and T. trichiura was greatest in western districts while hookworm infection was more evenly distributed across the country . CONCLUSION Mass antihelminthic treatment of school children was warranted in 13 of the 18 districts as more than 50 % of the children were infected with an intestinal nematode . It is likely that pre-school children are similarly infected Abstract Objective To estimate the effectiveness of delivering an anthelmintic through a community child health programme on the weight gain of preschool children in Ug and a. Design Cluster r and omised controlled trial . Setting Eastern Ug and a. Participants 48 parishes participating in a new programme for child health : 24 offered children an additional service of anthelmintic treatment . The outcome is based on measurements from 27 995 children . Intervention Treatment of children aged between 1 and 7 years with 400 mg albendazole added to st and ard services offered during child health days over a three year period . Main outcome measure Weight gain . Results The provision of periodic anthelmintic treatment as a part of child health services in Ug and a result ed in an increase in weight gain of about 10 % ( 166 g per child per year , 95 % confidence interval 16 to 316 ) above expected weight gain when treatments were given twice a year , and an increase of 5 % when the treatment was given annually . Conclusion Deworming of preschool children in Ug and a as part of regularly scheduled health services seems practical and associated with increased weight gain Output:

There are significant differences in program impact by gender , with numeracy and literacy differentially positively affected for girls , and by age , with treatment effects larger for the primary school aged sub sample . There are also significant treatment interactions for those living in households with more treatment-eligible children . There is no evidence of differential treatment effects on age at program eligibility or number of years of program eligibility . Mass deworming of preschool aged children in high prevalence communities in Ug and a result ed in no statistically significant gains in numeracy or literacy 7 - 12 years after program completion . Point estimates were positive but imprecise ; the study lacked sufficient power to rule out substantial positive effects or more modest negative effects . However , there is suggestive evidence that deworming was relatively more beneficial for girls , primary school aged children , and children living in households with other treated children .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Question In patients with hypertension , do electronic health ( e-health ) interventions improve blood pressure ( BP ) control and other outcomes ? Review scope Included studies compared e-health interventions with usual or st and ard care or attention control in patients with adequately or inadequately controlled hypertension . E-health interventions had to use portable , Web-based , interactive wireless communication devices and focus on self-care , self-management , self-care behavior change , or education . Studies of interventions that only displayed information ( not interactive ) , were only used for follow-up , or that mostly benefitted health care providers were excluded . Outcomes included physical outcomes ( inadequate BP control , systolic [ SBP ] and diastolic BP [ DBP ] , body mass index [ BMI ] , body weight , and cholesterol levels ) , and self-care behavioral outcomes ( sodium and alcohol intake , smoking , and physical activities ) . Review methods MEDLINE , EMBASE /Excerpta Medica , Cochrane Data base of Systematic Review s , Cochrane Central Register of Controlled Trials , CINAHL Plus , PsycINFO , SCOPUS , Web of Science , Joanna Briggs Institute EBP Data base , INSPEC , China Journal Net , and WanFang Data ( all 2000 to Nov 2017 ) were search ed for English- and Chinese- language r and omized controlled trials ( RCTs ) . 14 RCTs ( n = 3998 , mean age 50 to 68 y ) , ranging in size from 44 to 778 patients , met the selection criteria . Follow-up ranged from 3 to 24 months . Studies were conducted in various setting s , including primary care clinics , community health centers , and hospitals . Intervention strategies included BP monitoring , lifestyle modification techniques , and motivation and maintenance . 9 RCTs had adequate r and omization sequence generation , 6 concealed allocation , 4 blinded outcome assessors , and none adequately reported blinding participants . Main results Results for inadequate BP control , SPB , DBP , BMI , body weight , and sodium intake are in the Table . E-health interventions did not improve total cholesterol levels at 3 to 6 months after the intervention ( 3 RCTs ) ; or alcohol intake , smoking , or physical activity at 6 months after the intervention ( 3 RCTs ) . Conclusion In patients with hypertension , electronic health interventions reduce blood pressure levels and increase likelihood of blood pressure control . Electronic health interventions vs control in patients with hypertension * Outcomes Assessment times ( after intervention ) Number of trials ( n ) RRR ( 95 % CI ) NNT ( CI ) Inadequate BP control 3 to 12 mo 5 ( 1518 ) 31 % ( 16 to 43 ) 6 ( 4 to 11 ) Mean between-group difference ( CI ) Change in systolic BP ( mm Hg ) 6 mo 12 ( 3171 ) 5.50 ( 9.85 to 1.16 ) 12 mo 3 ( 1272 ) 7.68 ( 9.95 to 5.41 ) 18 mo 2 ( 735 ) 6.26 ( 9.29 to 3.23 ) Change in diastolic BP ( mm Hg ) 6 mo 12 ( 3171 ) 3.40 ( 7.79 to 0.99 ) 12 mo 3 ( 1272 ) 3.36 ( 4.80 to 1.92 ) 18 mo 2 ( 735 ) 2.53 ( 4.72 to 0.34 ) Change in body mass index ( kg/m2 ) 6 mo 5 ( 1486 ) 0.22 ( 0.46 to 0.02 ) 12 mo 3 ( 1272 ) 0.24 ( 0.82 to 0.33 ) 18 mo 2 ( 735 ) 0.07 ( 0.77 to 0.91 ) Change in body weight ( kg ) 3 to 6 mo 3 ( 517 ) 1.08 ( 2.04 to 0.13 ) Change in sodium intake ( SMD ) 6 mo 2 ( 768 ) 0.34 ( 0.49 to 0.20 ) 12 mo 2 ( 753 ) 0.39 ( 0.54 to 0.25 ) 18 mo 2 ( 735 ) 0.30 ( 0.45 to 0.16 ) * BP = blood pressure ; SMD = st and ardized mean difference ; other abbreviations defined in Glossary . Weighted electronic health intervention event rate , RRR , NNT , and CI calculated using control event rate and relative risk in article . Blood pressure 140/90 mm Hg . Weighted event rates 42 % vs 60 % . Commentary The systematic review and meta- analysis by Ma and colleagues showed a small but clinical ly meaningful reduction in SBP and DBP in patients who received e-health re sources . However , some health outcomes , including BMI and cholesterol levels , were not improved . Despite a risk for selection bias in some of the studies and substantial heterogeneity between studies , the meta- analysis is of high quality . The interventions in the included studies varied greatly and included use of telephone calls , Web sites , and smartphone applications . The comparison treatments were either attention control or usual care , and trials did not directly compare e-health interventions . The outcomes measured also varied among studies . Because clinic BP measurements may overestimate the degree of elevation and ambulatory monitoring is costly and limited to brief periods of measurement , home BP monitoring using newer e-health re sources may provide a cost-effective alternative ( 1 ) . This is an exciting new avenue for improving BP control by allowing for more accurate and streamlined monitoring , leading to more precise and timely interventions . However , based on the heterogeneity of intervention types , the optimum method is unknown . Further studies should directly compare e-health platforms and assess patient-centered outcomes , including usability , satisfaction , affordability , and quality of life as well as BP . Although the evidence indicates that these interventions are not yet ready for routine clinical practice , there is a promising signal that they could be useful for BP management Self-management schemes and mobile apps can be used for the management of hypertension in the community , but the most appropriate patient population is unknown . To explore whether the Chinese Health Literacy Scale ( CHLSH ) can be used to screen for appropriate patients with hypertension for self-management and to evaluate the clinical effectiveness and health economic evaluation of three hypertension management schemes . This was a prospect i ve study performed from March 2017 to July 2017 in consecutive patients with primary hypertension and of 50–80 years of age from the Jinyang community , Wuhou District , Chengdu . The CHLSH was completed and the patients were classified into the high ( n = 283 ) and low ( n = 315 ) health literacy groups . The patients were r and omly divided into the self-management , traditional management , and mobile app management groups . The high-health literacy group was selected to construct the cost-effectiveness decision tree model . Blood pressure control rate and the quality -adjusted life years ( QALYs ) were determined . At the end of follow-up , the success rate of self-management was 83.4 % . The costs for 6 months of treatment for each patient with hypertension in the self-management , traditional management , and mobile app groups were 1266 , 1751 , and 1856 yuan , respectively . The costs required for obtaining 1 QALY when managing for 6 months were : 30,869 yuan for self-management ; 48,628 yuan for traditional management ; and 43,199 yuan for the mobile app . The CHLSH can be used as a tool for screening patients with hypertension for self-management . The cost-effectiveness of self-management was optimal Output:

In fact , the observed results partially in contrast with those of numerous r and omized controlled trials have documented a significant BP reduction combined with an intensification and optimization of the use of antihypertensive medications in patients making use of blood pressure telemonitoring plus remote counseling by a case manager , with the supervision of a doctor or a community pharmacist [ 5 , 6 ] .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Given that retention rates for weight-loss trials have not significantly improved in the past 20 years , identifying effective techniques to enhance retention is critical . This paper describes a conceptual and practical advance that may have improved retention in a behavioral weight-loss trial-the novel application of motivational interviewing techniques to diffuse ambivalence during interactive group-based orientation sessions prior to r and omization . These orientation sessions addressed ambivalence about making eating and exercise behavior changes , ambivalence about joining a r and omized controlled trial , and unrealistic weight-loss expectations . During these sessions , overweight and obese men and women learned about the health benefits of modest weight loss as well as trial design , the importance of a control condition , r and om assignment and the impact of dropouts . Participants were then divided into groups of three or four , and asked to generate two pros and two cons of being assigned to a control condition and an active condition . Participants shared their pros and cons with the larger group , while the investigator asked open-ended questions , engaged in reflective listening and avoided taking a ' pro-change ' position . Retention was high , with 96 % of the participants ( N = 162 ) completing 18-month clinic visits Abstract Objective To estimate the effect of adding exercise classes , spinal manipulation delivered in NHS or private premises , or manipulation followed by exercise to “ best care ” in general practice for patients consulting with back pain . Fig 1 Progress of the UK BEAM trial Design Pragmatic r and omised trial with factorial design . Setting 181 general practice s in Medical Research Council General Practice Research Framework ; 63 community setting s around 14 centres across the United Kingdom . Participants 1334 patients consulting their general practice s about low back pain . Main outcome measures Scores on the Rol and Morris disability question naire at three and 12 months , adjusted for centre and baseline scores . Results All groups improved over time . Exercise improved mean disability question naire scores at three months by 1.4 ( 95 % confidence interval 0.6 to 2.1 ) more than “ best care . ” For manipulation the additional improvement was 1.6 ( 0.8 to 2.3 ) at three months and 1.0 ( 0.2 to 1.8 ) at 12 months . For manipulation followed by exercise the additional improvement was 1.9 ( 1.2 to 2.6 ) at three months and 1.3 ( 0.5 to 2.1 ) at 12 months . No significant differences in outcome occurred between manipulation in NHS premises and in private premises . No serious adverse events occurred . Conclusions Relative to “ best care ” in general practice , manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months ; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months ; and exercise achieved a small benefit at three months but not 12 months This study examined the role of a Medication Event Monitoring System ( MEMS ) to assess pill-taking behavior and enhance compliance within a r and omized trial of bupropion-SR for smoking cessation . Female participants ( N = 97 ) received MEMS bottles containing bupropion-SR 150 mg or placebo , to be taken twice daily . A r and omly selected “ feedback ” group of participants was told about the recording device in the bottle cap and received weekly graphic feedback showing their pill-taking behavior with specific instructions for improving compliance . A “ no-feedback ” group was not informed about the MEMS bottles , and did not receive further instruction or feedback beyond the st and ard dosing instructions . Compliance outcomes were the total doses taken and number of doses taken within the prescribed time interval . Results indicated significantly higher compliance over time for the feedback group . Participation in the feedback group predicted higher compliance beyond demographic , smoking , and health belief variables , suggesting significant benefit in providing brief feedback and instruction throughout the medication regimen Abstract Objective : To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care . Design : A before and after pragmatic cluster r and omised controlled trial utilising a two by two incomplete block design . Setting : 60 general practice s in north east Engl and . Participants : General practitioners and practice nurses in the study practice s and their patients aged 18 or over with angina or asthma . Main outcome measures : Adherence to the guidelines , based on review of case notes and patient reported generic and condition specific outcome measures . Results : The computerised decision support system had no significant effect on consultation rates , process of care measures ( including prescribing ) , or any patient reported outcomes for either condition . Levels of use of the software were low . Conclusions : No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care . This was probably due to low levels of use of the software , despite the system being optimised as far as was technically possible . Even if the technical problems of producing a system that fully supports the management of chronic disease were solved , there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex , multiple conditions OBJECTIVE To determine the effect of a voucher for free mammography on compliance with recommended mammography screening guidelines . STUDY DESIGN Vouchers for free mammography distributed to a r and om sample of women over the age of 50 in two rural southern Minnesota counties . The vouchers were good for one year . Baseline and follow-up data were collected and rates of compliance with current mammography guidelines were observed for the voucher group and a control group of women living in the same counties . METHODS Logistic regression models were used to estimate the effect of the voucher on compliance with mammography guidelines and the impact of factors potentially influencing the effectiveness of the voucher . PRINCIPAL FINDINGS The voucher improved mammography rates primarily through increasing screening among women who were out of compliance at baseline . CONCLUSIONS Vouchers , even when distributed r and omly within a population of rural Midwestern women , can significantly improve compliance rates . Vouchers are no less effective a means of increasing screening among vulnerable women than among other women Background Postal question naires are widely used to collect data in healthcare research but a poor response rate may reduce the validity and reliability of results . There was a lack of evidence available relating to use of a monetary incentive to improve the response rate in the healthcare setting . Methods The MRC ORACLE Children Study is assessing the health and development of nearly 9000 seven year old children whose mothers ' joined the MRC ORACLE Trial . We carried out a r and omised controlled trial of inclusion of monetary incentive ( five pound voucher redeemable at many high street stores ) with the reminder question naire to parents . This trial took place between April 2002 and November 2003 . When the parents were sent the reminder question naire about their child 's health and development they were r and omly assigned by concealed computer-generated allocation stratified by week of birthday to receive a five pound voucher or no incentive . The population were 722 non-responders to the initial mailing of a 12-page question naire . Main outcome measures : Difference in response rate between the two groups . Results Inclusion of the voucher with the reminder question naire result ed in a 11.7%(95 % CI 4.7 % to 18.6 % ) improvement in the response rate between the two groups . Conclusion This improvement in response rate and hence the validity and reliability of results obtained appears to be justified ethically and financially OBJECTIVE To test the efficacy of a prevention intervention to reduce sexual risk behavior among Latino adolescents . DESIGN R and omized controlled trial from April 2000 through March 2003 , with data collection before and after intervention and at 3 , 6 , and 12 months . SETTING Northeast Philadelphia schools . PARTICIPANTS Latinos aged 13 through 18 years ( 249 males and 304 females ) ; 81.6 % retained at 12-month follow-up . INTERVENTIONS The HIV and health-promotion control interventions consisted of six 50-minute modules delivered by adult facilitators to small , mixed-gender groups in English or Spanish . Main Outcome Measure Self-reported sexual behavior . RESULTS Analyses using generalized estimation equations over the follow-up period revealed that adolescents in the HIV intervention were less likely to report sexual intercourse ( odds ratio , 0.66 ; 95 % confidence interval [ CI ] , 0.46 - 0.96 ) , multiple partners ( odds ratio , 0.53 ; 95 % CI , 0.31 - 0.90 ) , and days of unprotected intercourse ( relative risk , 0.47 ; 95 % CI , 0.26 - 0.84 ) and more likely to report using condoms consistently ( odds ratio , 1.91 ; 95 % CI , 1.24 - 2.93 ) . Baseline sexual experience and language use moderated intervention efficacy . Adolescents assigned to the HIV intervention who were sexually inexperienced at baseline reported fewer days of unprotected sex ( relative risk , 0.22 ; 95 % CI , 0.08 - 0.63 ) ; Spanish speakers were more likely to have used a condom at last intercourse ( odds ratio , 4.73 ; 95 % CI , 1.72 - 12.97 ) and had a greater proportion of protected sex ( mean difference , 0.35 ; P<.01 ) compared with similar adolescents in the health-promotion intervention . CONCLUSION Results provide evidence for the efficacy of HIV intervention in decreasing sexual activity and increasing condom use among Latino adolescents Background It is notoriously difficult to recruit patients to r and omised controlled trials in primary care . This is particularly true when the disease process under investigation occurs relatively infrequently and must be investigated during a brief time window . Bell 's palsy , an acute unilateral paralysis of the facial nerve is just such a relatively rare condition . In this case study we describe the organisational issues presented in setting up a large r and omised controlled trial of the management of Bell 's palsy across primary and secondary care in Scotl and and how we managed to successfully recruit and retain patients presenting in the community . Methods Where possible we used existing evidence on recruitment strategies to maximise recruitment and retention . We consider that the key issues in the success of this study were ; the fact that the research was seen as clinical ly important by the clinicians who had initial responsibility for recruitment ; employing an experienced trial co-ordinator and dedicated research ers willing to recruit participants seven days per week and to visit them at home at a time convenient to them , hence reducing missed patients and ensuring they were retained in the study ; national visibility and repeated publicity at a local level delivered by locally based principal investigators well known to their primary care community ; encouraging recruitment by payment to practice s and reducing the workload of the referring doctors by providing immediate access to specialist care ; good collaboration between primary and secondary care and basing local investigators in the otolarnygology trial centres Results Although the recruitment rate did not meet our initial expectations , enhanced retention meant that we exceeded our planned target of recruiting 550 patients within the planned time-scale . Conclusion While difficult , recruitment to and retention within multi-centre trials from primary care can be successfully achieved through the application of the best available evidence , establishing good relationships with practice s , minimising the workload of those involved in recruitment and offering enhanced care to all participants . Primary care trialists should describe their experiences of the methods used to persuade patients to participate in their trials when publishing their results STUDY OBJECTIVE For orthopaedic out patients judged as unlikely to require surgery , how does the cost-effectiveness of treatment from a musculo-skeletal medicine physician compare with that of a conventional orthopaedic surgeon-led service ? DESIGN Partially r and omised , pragmatic trial comparing management from a single musculo-skeletal medicine physician with orthopaedic surgeon-led management , with the timing and nature of treatments at the discretion of individual clinicians . Main outcomes were : change in patient reported health ( SF-36 and EuroQol ) , and marginal health service costs . SETTING Outpatient department of an Edinburgh orthopaedic hospital . SUBJECTS One thous and three hundred and twenty six people ; aged over 18 , referred to and later attending the outpatient department with a ' non-surgical ' musculo-skeletal condition , who provided baseline information . Eight hundred and twenty nine were r and omly allocated to management by either the musculo-skeletal medicine physician ( medical group ) or a conventional orthopaedic surgeon-led service ( surgical group ) ; 497 were assigned to the treatment groups according to their general practitioner 's preference . RESULTS There are aspects of the study design concerning statistical power , potential selection bias and generalisability , which mean that any results must be treated with caution . Although there was no statistically significant difference in health gain between the r and omly allocated groups ( with similar findings in the non-r and omised medical and surgical groups ) , the patient groups were heterogeneous and the confidence intervals did not rule out clinical ly important differences . The medical group received more outpatient treatment , 20 % vs. 10 % ( difference 95 % CI 5 % to 15 % ) with a higher rate of physiotherapy referral , 45 % vs. 30 % ( 15 % , 9 % to 22 % ) . The surgical group received more inpatient surgical care 6 % vs. 17 % ( -11 % , -15 % to -7 % ) . Mean healthcare costs in the medical group were 179 Pounds per patient compared with 287 Pounds in the surgical group ( -108 Pounds , -25 Pounds to -191 Pounds ) . CONCLUSIONS Interpretation should take into account the practical difficulties and circumstances of the study . Although no differences in health gain were found between these two management policies for ' non-surgical ' orthopaedic out patients , the trial was less statistically powerful than planned and the confidence intervals included clinical ly important differences . Differences in treatment emphasis gave estimated costs savings to the Health Service of 108 Pounds per patient treated by the musculo-skeletal Output:

There was no good evidence that the addition of a non-monetary incentive , an offer of a non-monetary incentive , ' enhanced ' letters , letters delivered by priority post , additional reminders , or question naire question order either increased or decreased trial question naire response/retention . There were few evaluations of ways to improve participants returning to trial sites for trial follow-up . Monetary incentives and offers of monetary incentives increased postal and electronic question naire response . Key results The methods that appeared to work were offering or giving a small amount of money for return of a completed question naire and enclosing a small amount of money with a question naire with the promise of a further small amount of money for return of a filled in question naire .

MS2_1shot516

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE This study assessed the effect of a h and held computer-based decision support system ( DSS ) on antibiotic use and patient outcomes in a critical care unit . DESIGN A DSS containing four types of evidence ( patient microbiology reports , local antibiotic guidelines , unit-specific antibiotic susceptibility data for common bacterial pathogens , and a clinical pulmonary infection score calculator ) was developed and implemented on a h and held computer for use in the intensive care unit at a tertiary referral hospital . System impact was assessed in a prospect i ve " before/after " cohort trial lasting 12 months . Outcome measures were defined daily doses ( DDDs ) of antibiotics per 1,000 patient-days , patient length of stay , and mortality . RESULTS The number of admissions , APACHE ( Acute Physiology , Age , and Chronic Health Evaluation ) II and SAPS ( Simplified Acute Physiology Score ) II for patients in preintervention , and intervention ( DSS use ) periods were statistically comparable . The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days ( p = 0.02 ) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days ( p = 0.04 ) , respectively , with no change in mortality . The DSS was accessed 674 times during 168 days of the trial . Microbiology reports and antibiotic guidelines were the two most commonly used ( 53 % and 22.5 % , respectively ) types of evidence . The greatest reduction was observed in the use of beta-lactamase-resistant penicillins and vancomycin . CONCLUSION H and held computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit The purpose of the study was to compare the proportion of obesity-related diagnoses in clinical encounters ( N = 1874 ) documented by nurses using a personal digital assistant-based log with and without obesity decision support features . The experimental group encounters in the r and omized controlled trial had significantly more ( P = .000 ) obesity-related diagnoses ( 11.3 % ) than did the control group encounters ( 1 % ) and a significantly lower false negative rate ( 24.5 % vs 66.5 % , P = .000 ) . The study findings provide evidence that integration of a decision support feature that automatically calculates an obesity-related diagnosis increases diagnoses and decreases missed diagnoses and suggest that such systems have the potential to improve the quality of obesity-related care Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system ( CDSS ) on nonsteroidal anti-inflammatory drug ( NSAID ) prescribing safety in the outpatient setting . DESIGN The design was a r and omized , controlled trial conducted in a university-based resident clinic . Internal medicine residents received a PDA-based CDSS suite . For intervention residents , the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations . Unannounced st and ardized patients ( SPs ) trained to portray musculoskeletal symptoms presented to study physicians . Safety outcomes were assessed from the prescriptions given to the SPs . Each prescription was review ed by a committee of clinicians blinded to participant , intervention group assignment , and baseline or follow-up status . MEASUREMENTS Prescriptions were judged as safe or unsafe . The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group . RESULTS At baseline , the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar ( 0.27 vs. 0.29 , p > 0.05 ) . Controlling for baseline performance , intervention participants prescribed more safely than controls after receiving the CDSS ( 0.23 vs. 0.45 [ F = 4.24 , p < 0.05 ] ) . With the CDSS , intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs . CONCLUSION PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS Summary Background Health workers ' malaria case-management practice s often differ from national guidelines . We assessed whether text-message reminders sent to health workers ' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya . Methods From March 6 , 2009 , to May 31 , 2010 , we did a cluster-r and omised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya . With a computer-generated sequence , health facilities were r and omly allocated to either the intervention group , in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months , or the control group , in which health workers did not receive any text messages . Health workers were not masked to the intervention , although patients were unaware of whether they were in an intervention or control facility . The primary outcome was correct management with artemether-lumefantrine , defined as a dichotomous composite indicator of treatment , dispensing , and counselling tasks concordant with Kenyan national guidelines . The primary analysis was by intention to treat . The trial is registered with Current Controlled Trials , IS RCT N72328636 . Findings 119 health workers received the intervention . Case-management practice s were assessed for 2269 children who needed treatment ( 1157 in the intervention group and 1112 in the control group ) . Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points ( 95 % CI 7·6–40·0 ; p=0·004 ) immediately after intervention and by 24·5 percentage-points ( 8·1–41·0 ; p=0·003 ) 6 months later . Interpretation In re source -limited setting s , malaria control programmes should consider use of text messaging to improve health workers ' case-management practice s. Funding The Wellcome Trust OBJECTIVE To examine whether Palm Prevention , a free software tool for Palm OS personal digital assistants ( PDAs ) that provides quick access to preventive guidelines in a patient-specific manner at the point of care , improved adherence to five preventive measures in primary care . DESIGN Prospect i ve intervention pilot study . SETTING Vancouver , BC , and surrounding area . PARTICIPANTS Eight general practitioners . INTERVENTIONS Each physician used Palm Prevention for five preventive measures during routine preventive health visits with 10 patients ( n = 80 ) . Charts of consenting patients were review ed for documentation of recommended maneuvers . MAIN OUTCOME MEASURES Rates of adherence to five evidence -based guidelines selected from the Canadian and American task forces on preventive care and incorporated into Palm Prevention . RESULTS Intervention and control physicians were similar in their familiarity with and use of PDAs , and they recruited similar patients for the study . Intervention and control groups had similar rates of screening for hypertension . Intervention improved adherence to the remaining four guidelines : cervical cancer screening increased 22 % ( only absolute increases are reported ) ; hyperlipidemia screening increased 30 % ; colorectal cancer screening increased 27 % ; and prophylaxis with acetylsalicylic acid in high-risk patients increased 38 % . Participants were surveyed after the study ; all reported that they found the software helpful and would continue using Palm Prevention . Usage statistics showed that study participants used the tool outside the trial : users entered between 28 and 68 unique patients into the program during the 2-month intervention . CONCLUSION This pilot study suggests PDAs are useful in improving preventive care and facilitating translation of knowledge into practice . This was particularly apparent with newer guidelines OBJECTIVE Personal digital assistants ( PDAs ) are popular with physicians : in 2003 , 33 % of Canadian doctors reported using them in their practice s. We do not know , however , whether using a PDA changes the behaviour of practising physicians . We studied the effectiveness of a PDA software application to help family physicians diagnose angina among patients with chest pain . DESIGN Prospect i ve r and omized controlled pilot trial using a cluster design . SETTING Primary care practice s in the Toronto area . PARTICIPANTS Eighteen family physicians belonging to the North Toronto Primary Care Research Network ( Nortren ) or recruited from a local hospital . INTERVENTIONS We r and omized physicians to receive a Palm PDA ( which included the angina diagnosis software ) or to continue conventional care . Physicians prospect ively recorded the process of care for patients aged 30 to 75 presenting with suspected angina , over 7 months . MAIN OUTCOME MEASURES Did the process of care for patients with suspected angina improve when their physicians had PDAs and software ? The primary outcomes we looked at were frequency of cardiac stress test orders for suspected angina , and the appropriateness of referral for cardiac stress testing at presentation and for nuclear cardiology testing after cardiac stress testing . Secondary outcome was referrals to cardiologists . RESULTS The software led to more overall use of cardiac stress testing ( 81 % vs 50 % ) . The absolute increase was 31 % ( P = .007 , 95 % confidence interval [ CI ] 8 % to 58 % ) . There was a trend toward more appropriate use of stress testing ( 48.6 % with the PDA vs 28.6 % control ) , an increase of 20 % ( P = .284 , 95 % CI -11.54 % to 51.4 % ) . There was also a trend toward more appropriate use of nuclear cardiology following cardiac stress testing ( 63.0 % vs 45.5 % ) , an absolute increase of 17.5 % ( P = .400 , 95 % CI -13.9 % to 48.9 % ) . Referrals to cardiologists did not increase ( 38.2 % with the PDA vs 40.9 % , P = .869 ) . CONCLUSION A PDA-based software application can lead to improved care for patients with suspected angina seen in family practice s ; this finding requires confirmation in a larger study OBJECTIVE To assess the acceptability and usage of a st and alone personal digital assistant (PDA)-based clinical decision-support system ( CDSS ) for the diagnosis and management of acute respiratory tract infections ( RTIs ) in the outpatient setting . DESIGN Observational study performed as part of a larger r and omized trial in six rural communities in Utah and Idaho from January 2002 to March 2004 . Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care , and were asked to use the tool with at least 200 patients with suspected RTIs . MEASUREMENTS Clinical data were collected electronically from the devices at periodic intervals . Providers also completed an exit question naire at the end of the study period . RESULTS Providers logged 14,393 cases using the CDSS , the majority of which ( n=7624 ; 53 % ) were from family practitioners . Overall adherence with CDSS recommendations for the five most common diagnoses ( pharyngitis , otitis media , sinusitis , bronchitis , and upper respiratory tract infection ) was 82 % . When antibiotics were prescribed ( 53 % of cases ) , adherence with the CDSS-recommended antibiotic was high ( 76 % ) . By logistic regression analysis , the odds of adherence with CDSS recommendations increased significantly with each ten cases completed ( P=0.001 ) . Question naire respondents believed the CDSS was easy to use , and most ( 44/65 ; 68 % ) did not believe it increased their encounter time with patients , regardless of prior experience with PDAs . CONCLUSION A st and alone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practice s and easily gather a rich set of clinical data BACKGROUND Testing for pulmonary embolism often differs from that recommended by evidence -based guidelines . OBJECTIVE To assess the effectiveness of a h and held clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department . DESIGN Cluster r and omized trial . Assignment was by r and om-number table , providers were not blinded , and outcome assessment was automated . ( Clinical Trials.gov registration number : NCT00188032 ) . SETTING 20 emergency departments in France . PATIENTS 1103 and 1768 consecutive out patients with suspected pulmonary embolism . INTERVENTION After a preintervention period involving 20 centers and 1103 patients , in which providers grew accustomed to inputting clinical data into h and held devices and investigators assessed baseline testing , emergency departments were r and omly assigned to activation of a decision-support system on the devices ( 10 centers , 753 patients ) or posters and pocket cards that showed vali date d diagnostic strategies ( 10 centers , 1015 patients ) . MEASUREMENTS Appropriateness of diagnostic work-up , defined as any sequence of tests that yielded a posttest probability less than 5 % or greater than 85 % ( primary outcome ) or as strict adherence to guideline recommendations ( secondary outcome ) ; number of tests Output:

Effectiveness was demonstrated across three distinct functions that emerged from the data : accessing information for clinical knowledge , adherence to guidelines and diagnostic decision making . When healthcare professionals used h and held computers to access clinical information , their knowledge improved significantly more than peers who used paper re sources . When clinical guideline recommendations were presented on h and held computers , clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper re sources . Finally , healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on h and held computers compared to colleagues who did not have access to these tools . Conclusion Healthcare professionals ’ use of h and held computers may improve their information seeking , adherence to guidelines and clinical decision making . H and held computers can provide real time access to and analysis of clinical information . The integration of clinical decision support systems within h and held computers offers clinicians the highest level of synthesis ed evidence at the point of care .

MS2_1shot517

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Women have higher rates of knee ligament injury than men . Co-contraction of knee muscles is proposed to be an important mechanism to protect the joint from injuries . HYPOTHESIS Females have lower co-contraction levels when compared to males . STUDY DESIGN Exploratory , cross-sectional design . METHODS Thirty-six men and women equally divided into four groups according to gender and activity level ( sedentary and athletic ) were compared in relation to vastus lateralis and biceps femoris co-contraction before heel strike during level walking and before floor contact during l and ing from a jump . Muscular co-contraction was assessed by surface electromyography . Correlations between co-contraction and ligament laxity , extensor and flexor work , and flexion/extension torque ratio were also analyzed . RESULTS No differences between genders were found in the studied situations ( p0.381 ) . During walking , co-contraction was greater in sedentary women compared to athletic women ( p=0.002 ) . A moderate inverse correlation was found between co-contraction during walking and women extensor ( r=-0.613 ; p=0.007 ) and flexor ( r=-0.575 ; p=0.012 ) work . During l and ing from a jump , no variables correlated to co-contraction in any of the groups tested ( r0.477 ; p0.061 ) . CONCLUSION Co-contraction levels were not different between genders . Results suggest that women compensate strength deficits by means of increasing activation levels , possibly to generate adequate joint stiffness to meet stabilization dem and s. However , this is not evident in a more stressful activity like l and ing from a jump . CLINICAL RELEVANCE This study contributes to a better underst and ing of the factors related to joint protection in females , who are at a greater risk of ligament injuries BACKGROUND Despite recent evidence supporting the use of neuromuscular training to reduce anterior cruciate ligament injury risk , female athletes continue to show an increased anterior cruciate ligament injury rate in collegiate basketball and soccer when compared to males . The purpose of the current study was to identify gender and task differences in measures that may increase the risk of anterior cruciate ligament injury in female basketball and soccer athletes . METHODS Eleven female and 11 male collegiate basketball and soccer athletes were height ( female mean 176 ( SD 8 cm ) , male mean 176 ( SD 8 cm ) ) and weight ( female mean 73 ( SD 7 kg ) , male mean 74 ( SD 6 kg ) ) matched . Three-dimensional motion analysis was used to calculate differences in total coronal plane angular joint excursion ( maximum-minimum ) between male and female athletes when performing a series of medially and laterally directed drop l and ings . FINDINGS Female athletes demonstrated increased total coronal plane excursion for the hip , knee and ankle ( P < 0.05 ) during the medial drop l and ing . During the lateral drop l and ing females displayed increased excursion at the hip and knee . When comparing tasks , the lateral drop l and ing result ed in greater coronal plane excursion at the hip ( P < 0.05 ) while the knee showed no differences between movements . In contrast , females demonstrated increased ankle excursion during the medial drop task ( P < 0.05 ) . INTERPRETATION Female athletes demonstrate increased lower extremity coronal plane excursion when performing single leg drop l and ing in both the medial and lateral direction when compared to height/weight matched male athletes . This increased coronal plane oscillation of lower extremity joints may be related to the increased risk of anterior cruciate ligament injury for female basketball and soccer athletes BACKGROUND It is thought that female athletes with limited experience in a sport perform athletic maneuvers differently than their more experienced counterparts , and that they do so in a manner that places them at greater risk for injury . The purpose of this study was to evaluate the influence of athletic experience on knee mechanics during the execution of a side-step cutting maneuver in young female athletes . METHODS Three-dimensional kinematics , ground reaction forces and electromyographic activity ( surface electrodes ) were recorded during the early deceleration phase of side-step cutting in 30 high school females ( 15 experienced , 15 novice ) . Group differences in knee joint kinematics , peak moments , net joint moment impulse and average muscle activation were evaluated . FINDINGS No significant group differences were found in knee kinematics . When compared to experienced females , novice females demonstrated significantly smaller flexor , adductor , and internal rotator peak moments and smaller net joint moment impulse in all three planes at the knee . No group differences were found for average EMG ; however , novice athletes had significantly greater co-contraction at the knee . INTERPRETATION The finding of smaller knee moments and greater muscle co-contraction in the novice group suggests that these athletes may adopt a protective strategy in response to a relatively unfamiliar task . In addition , these results suggest that increased moments at the knee emerge with experience , indicating that more skilled athletes may be at greater risk for anterior cruciate ligament ( ACL ) injury BACKGROUND AND PURPOSE Dynamic knee stabilization strategies of people who successfully compensate for the absence of an anterior cruciate ligament ( ACL ) ( " copers " ) are different from those of people who do not compensate well for the injury ( " noncopers " ) . Early after injury , certain patients ( " potential copers " ) can increase the likelihood of successfully compensating for the injury by participating in 10 sessions of perturbation training . The purpose of this study was to determine how perturbation training alters muscle co-contraction and knee kinematics in potential copers . SUBJECTS Seventeen individuals with acute , unilateral ACL rupture who were categorized as potential copers and 17 subjects without injuries who were matched by age , sex , and activity level were recruited for this study . METHODS Motion analysis and electromyographic data were collected as subjects walked across a stationary or moving platform ( horizontal translation ) before and after perturbation training . RESULTS Before training , potential copers had higher co-contraction indexes and lower peak knee flexion angles than subjects without injuries . After training , potential copers ' movement patterns more closely resembled those of subjects without injuries ( ie , they showed reduced co-contraction indexes and increased peak knee flexion angles during stance ) . DISCUSSION AND CONCLUSION Perturbation training reduced quadriceps femoris-hamstring muscle and quadriceps femoris-gastrocnemius muscle co-contractions and normalized knee kinematics in individuals with ACL rupture who were classified as potential copers . Findings from this study provide evidence for a mechanism by which perturbation training acts as an effective intervention for promoting coordinated muscle activity in a select population of people with ACL rupture Background Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes . Hypothesis Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading , predicting anterior cruciate ligament injury risk . Study Design Cohort study ; Level of evidence , 2 . Methods There were 205 female athletes in the high-risk sports of soccer , basketball , and volleyball prospect ively measured for neuromuscular control using 3-dimensional kinematics ( joint angles ) and joint loads using kinetics ( joint moments ) during a jump-l and ing task . Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament . Results Nine athletes had a confirmed anterior cruciate ligament rupture ; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture . Knee abduction angle ( P < . 05 ) at l and ing was 8 ° greater in anterior cruciate ligament-injured than in uninjured athletes . Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment ( P < . 001 ) and 20 % higher ground reaction force ( P < . 05 ) , whereas stance time was 16 % shorter ; hence , increased motion , force , and moments occurred more quickly . Knee abduction moment predicted anterior cruciate ligament injury status with 73 % specificity and 78 % sensitivity ; dynamic valgus measures showed a predictive r2 of 0.88 . Conclusion Knee motion and knee loading during a l and ing task are predictors of anterior cruciate ligament injury risk in female athletes . Clinical Relevance Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury . The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective , targeted interventions Output:

The relationship between adequate dynamic joint stability and efficient movement patterns are complex . Adequate antagonistic co-contraction of hamstring musculature seems to be a component of all functional movements , possibly maintain dynamic knee stability and protect against excessive joint loads .

MS2_1shot518

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Although question naires are used frequently with patients to self-report the severity of dyspnea as related to activities of daily living , the reliability of these instruments has not been established . The two purpose s of this study were to examine the test-retest reliability of three widely used dyspnea instruments and to compare dyspnea scores at different stages of disease . METHODS At paired baseline visits , 101 stable patients with COPD were tested ; at paired follow-up visits at 3 months , 89 of these patients were tested . At each visit , patients rated dyspnea with three instruments presented in r and om order and then performed post-bronchodilator therapy lung function tests . RESULTS Patient-reported dyspnea scores and lung function were similar at baseline ( interval , 6 + /- 5 days ) and follow-up visits ( interval , 4 + /- 2 days ) . Intraclass correlation coefficients at baseline and at follow-up were 0.82 and 0.82 , respectively , for the modified Medical Research Council scale ; 0.90 and 0.84 , respectively , for the self-administered computerized versions of the baseline dyspnea index and transition dyspnea indexes ; and 0.95 and 0.89 for the University of San Diego Shortness of Breath Question naire results . Dyspnea ratings were significantly related to the stage of disease severity based on percent predicted FEV(1 ) ( p < 0.001 ) . CONCLUSIONS Test-retest reliability was acceptable for patient-reported dyspnea scores using three clinical instruments at baseline and at the 3-month follow-up . Our results demonstrate for the first time that patient-reported dyspnea ratings are related to the stage of disease severity Reproducibility and validity are prerequisites for a useful clinical scale . We therefore prospect ively tested the reproducibility and validity of the New York Heart Association criteria and the Canadian Cardiovascular Society criteria for the assessment of cardiac functional class and compared these criteria with a new Specific Activity Scale based on the metabolic costs of specific activities . The New York Heart Association estimates made by two physicians had a reproducibility of only 56 % , and only 51 % of the estimates agreed with treadmill exercise performance . Functional estimates based on the Canadian Cardiovascular Society criteria were significantly more reproducible ( 73 % ) , but not significantly more valid . The Specific Activity Scale was as reproducible as the Canadian Cardiovascular Society criteria , and its 68 % validity was significantly higher than the validities of the other systems . The easily administered Specific Activity Scale was equally reproducible and valid when used by a nonphysician . It was especially better than the other systems for the evaluation of true class II patients and was significantly less likely to underestimate treadmill performance . Although no set of questions can perfectly predict exercise tolerance , the Specific Activity Scale deserves wider prospect i ve testing PURPOSE Overweight and obese subjects often perceive increased breathlessness during minor exertion and therefore avoid exercise . Respiratory muscle endurance training ( RMET ) can reduce the perception of breathlessness . We hypothesized that RMET 1 month before and during a 6-month ( 3 months supervised + 3 months unsupervised ) exercise and nutrition counseling program ( EN ) would improve the benefits of EN . METHODS Twenty-six overweight and obese subjects with significant perception of breathlessness during exercise ( age = 33 ± 9 yr , body mass index ( BMI ) = 31.3 ± 4.9 kg·m(-2 ) ) were r and omized to RMET+EN ( R+EN ) or EN alone . R+EN performed 30 min of normocapnic hyperpnea 5 wk(-1 ) before and 2 wk(-1 ) during EN . EN consisted of two strength and three endurance training sessions per week , as well as prescribed nutritional composition and a 2.1-kJ ( 500-kcal ) energy deficit per day . Both groups had an equal number of laboratory visits during the 7 months . Before and after 4 and 7 months , subjects performed a 12-min time trial ( TT ; 6 + 6 min , 2-min pause ) and an incremental cycling test ( ICT ) to exhaustion , and blood lipids were assessed . RESULTS Weight loss was significant and similar in both groups ( -4.2 vs -3.7 kg ; both P < 0.05 ) . During the first 4 months , distance covered in 12 min improved more ( P < 0.05 ) with R+EN ( 1678 vs 1824 m ; P < 0.001 ) than with EN alone ( 1638 vs 1698 m ; P < 0.05 ) , whereas after R+EN , breathlessness during the ICT was reduced . Blood lipids of the pooled group improved in those subjects with pathologic values before the study . Despite reduced training compliance during the unsupervised period , subjects of both groups maintained the benefits attained during the supervised period . CONCLUSIONS R+EN improved TT performance more than EN alone , despite similar weight loss , possibly owing to the reduced perception of breathlessness OBJECTIVE Our objective was to study the effects of physical training combined with dietary measures in obese adults . In a second step , we sought to compare two training protocol s and establish the additional contribution of strength training . METHODS We performed a r and omized , prospect i ve survey from July 2004 to November 2007 . Included patients were r and omized into three groups : a control group ( G1 ) , a group ( G2 ) performing dietary measures and a programme of treadmill training at 60 % of each individual 's maximum heart rate ( HRmax ) and a group ( G3 ) who followed the G2 programme supplemented with strength training . All patients underwent an initial and final assessment of anthropometric & cardiovascular parameters , muscle strength , dyspnoea during activities of daily living , metabolic disorders , psychological status and quality of life . RESULTS The greatest weight loss ( 7.24 % ) was observed in G3 . Reduction in waistline measurement ( WL ) of 4.3 % and 10.26 % were noted in G2 and G3 , respectively ( p < 0.001 ) . The percentage fat body mass fell by 10.4 % in G3 ( p < 0.001 ) and 8.6 % in G2 ( p = 0.03).We particularly noted an improvement in physical condition in groups 2 and 3 , with lower HR and blood pressure values at rest and at maximum effort . The overall improvement in both arm and leg muscle strength was greater for G3 than for G2 . Likewise , we noted an improvement in the metabolic parameters and depression & anxiety scores for the trained groups ( G2 , G3 ) , relative to the control group ( G1 ) . We also noted improvements in the total impact of weight on quality of life ( IWQOL ) lite score of 15.2 % in G2 and 18 % in G3 . CONCLUSION Our survey demonstrated the beneficial effect of combining dietary measures and physical training in obese patients . In addition to weight loss , the programme enabled a reduction in the patients ' body fat mass and abdominal obesity , a correction of metabolic disorders and an improvement in aerobic capacity . The improvement in all these parameters also enhanced the patients ' psychological status and quality of life . The addition of strength training produced notable improvements in weight loss , arm muscle strength and abdominal obesity We mimicked important mechanical and ventilatory aspects of restrictive lung disorders by employing chest wall strapping ( CWS ) and dead space loading ( DS ) in normal subjects to gain mechanistic insights into dyspnea causation and exercise limitation . We hypothesized that thoracic restriction with increased ventilatory stimulation would evoke exertional dyspnea that was similar in nature to that experienced in such disorders . Twelve healthy young men [ 28 + /- 2 ( SE ) yr of age ] completed pulmonary function tests and maximal cycle exercise tests under four conditions , in r and omized order : 1 ) control , 2 ) CWS to 60 % of vital capacity , 3 ) added DS of 600 ml , and 4 ) CWS + DS . Measurements during exercise included cardiorespiratory parameters , esophageal pressure , and Borg scale ratings of dyspnea . Compared with control , CWS significantly reduced the tidal volume response to exercise , increased dyspnea intensity at any given work rate or ventilation , and thus limited exercise performance . DS stimulated ventilation but had minimal effects on dyspnea and exercise performance . Adding DS to CWS further increased dyspnea by 1.7 + /- 0.6 st and ardized Borg units ( P = 0.012 ) and decreased exercise performance ( total work ) by 21 + /- 6 % ( P = 0.003 ) over CWS alone . Across conditions , increased dyspnea intensity correlated best with decreased resting inspiratory reserve volume ( r = -0.63 , P < 0.0005 ) . Dyspnea during CWS was described primarily as " inspiratory difficulty " and " unsatisfied inspiration , " similar to restrictive disorders . In conclusion , severe dyspnea and exercise intolerance were provoked in healthy normal subjects when tidal volume responses were constrained in the face of increased ventilatory drive during exercise BACKGROUND Maximal incremental exercise testing should be completed within 8 - 12 minutes . The ramp-slope influences the exercise duration . Oxygen-cost diagram ( OCD ) is a scoring scale for the capability of daily activity performed and therefore can be used to estimate the ramp-slope . METHODS The OCD-algorithm and the reported-algorithm were used prospect ively in r and om order for selecting optimal ramp-slope : Ramp-slope(OCD)=Score(OCD)xweight in kg/40 for men and weight/50 for women and Ramp-slope(reported)=(Predicted V(O2peak)-V(O2unloaded))/100 . Fifty-three dyspneic patients and 16 normal controls were enrolled to perform a ramp-pattern exercise . Fourteen patients not reaching maximum exercise levels were excluded . The exercise capacity , exercise time , and success rate of loaded exercise between 8 and 12 minutes were measured . RESULTS Comparing the reported-algorithm to the OCD-algorithm in normal controls , the only difference was that the ramp-slope was higher in males ; in patients , the ramp-slope was higher in males , the exercise time shorter and the success rate lower ( 8.6+/-3.3 vs. 9.4+/-2.1 min , 61.5 % vs. 84.6 % , both p<0.05 ) ; in obese patients , the ramp-slope was lower and the exercise time longer . CONCLUSION OCD score can predict the ramp-slope selection for exercise testing in normal controls and dyspneic patients . This may be affected by gender and body weight when using the reported-algorithm for dyspneic patients AIM To describe changes in chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting ( CABG ) and to define factors at the time of operation that were associated with the occurrence of these symptoms after 15 years . DESIGN Prospect i ve observational study in western Sweden . SUBJECTS All patients who underwent first-time CABG , without simultaneous valve surgery , between 1 June 1988 and 1 June 1991 . There were no exclusion criteria . FOLLOW-UP All patients were followed up prospect ively for 15 years . The evaluation of symptoms took place through postal question naires prior to and 5 , 10 and 15 years after the operation . RESULTS Totally , 2000 patients were included in the survey and 904 ( 45 % ) of them survived to 15 years . Among these 904 survivors , the percentage of patients with chest pain increased from 44 % to 50 % between the 5- and 15-year follow-up ( p=0.004 ) . The percentage of patients who reported symptoms of dyspnoea increased from 60 % after 5 years to 74 % after 15 years ( p<0.001 ) . Factors at the time of surgery that independently tended to predict chest pain after 15 years were higher age ( p=0.04 ) and prolonged duration of symptoms prior to surgery ( p=0.04 ) . Predictors of dyspnoea after 15 years were higher age ( p<0.0001 ) , the use of inotropic drugs at the time of surgery ( p=0.001 ) , a history of diabetes ( p=0.01 ) and obesity ( p=0.01 ) . CONCLUSION After CABG , relief from chest pain and dyspnoea is generally maintained over a long period of time . Eventually , however , functional-limiting symptoms tend to recur and about half the patients report symptoms of chest pain , while three-quarters report dyspnoea after 15 years . Even if no clear predictor of chest pain was found at the time of surgery , age , the use of inotropic drugs , diabetes and obesity predicted dyspnoea The primary purpose of this study was to determine if there are three distinct factors representing ratings of dyspnea during laboratory exercise , clinical ratings of dyspnea , and pulmonary function in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) ( n = 92 ) using factor analysis . Subjects ( mean age 66 + /- 7 yrs ; FEV1 % predicted 44.7 + /- 14.0 ) were r and omly assigned to one of three treatment groups to test the effects of three education and exercise training programs . Outcomes were evaluated at baseline and at 2 months after the intervention . Dyspnea ratings with laboratory exercise ( SOB ) were measured during incremental ( ITT ) and endurance ( ETT ) treadmill tests , and a six-minute walk ( 6MW ) using the modified Borg scale . Clinical measures of dyspnea were measured with the Baseline and Transitional Dyspnea Index ( BDI Output:

If sensation drives behavior , comprehensive data on the sensation of breathlessness might assist in underst and ing the behavioral consequences of interventions

MS2_1shot519

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Purpose : Non-steroidal anti-inflammatory drugs ( NSAIDs ) are used as analgesic in postoperative pain to reduce opioid side effects , such as drowsiness and nausea . However , NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric , renal , and coagulation parameters . This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients . Methods : One hundred and twenty patients scheduled for elective CABG surgery were enrolled in r and omized , double blind , controlled study . St and ardized fast track cardiac anesthesia was used . One dose of drug ( 75 mg diclofenac , 100 mg ketoprofen , 100 mg indomethacin , or placebo ) was givenpr one hour before tracheal extubation and a second dose 12 hr later . Pain was treated with morphineiv and acetaminophenpo . Visual analogue pain scores were recorded at baseline , 3 , 6 , 12 and 24 hr after the first dose of drug . Results : There were no differences among the groups in pain scores . Only patients who received diclofenac required less morphine than patients in the control group ( P<0.05 ) . When the total amounts of pain medications were computed to morphine equivalents , only patients in the diclofenac group received less pain medications than the placebo group ( P<0.05 ) . Proportion of patients with postoperative increase of creatinine level ( 20 % and over ) did not differ between placebo and drug groups . Conclusion : Non-steroidal anti-inflammatory drugs may be used for anaalgesia management post CABG surgery in selected patients . Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively . RésuméObjectif : Les anti-inflammatoires non stéroïdiens ( AINS ) servent d’analgésique postopératoire et réduisent les effets secondaires des opioïdes , comme la somnolence et les nausées . Leur emploi en cardiochirurgie est plutôt restreint où on craint des effets gastriques et rénaux indésirables et des modifications de la coagulation . On a voulu évaluer l’efficacité et la sécurité d’emploi analgésique de trois AINS chez des patients qui subissent un pontage aortocoronarien . Méthode : L’étude r and omisée , contrôlée et à double insu a porté sur 120 patients qui devaient subir un pontage aortocoronarien . Une anesthésie cardiaque normalisée pour un séjour hospitalier écourté a été utilisée . Une dose de médicament ( 75 mg de diclofénac , 100 mg de kétoprofène , 100 mg d’indométhacine , ou un placebo ) a été administréepr une heure avant l’extubation endotrachéale et une seconde dose 12 h plus tard . La douleur a été traitée avec de la morphineiv et de l’acétaminophènepo . Les scores de douleur ont été enregistrés à l’échelle visuelle analogique au début , puis 3 , 6 , 12 et 24 h après la première dose de médicament . Résultats : Les scores de douleur n’ont pas présenté de différence intergroupe . Seuls les patients du groupe diclofénac ont dem and é moins de morphine que ceux du groupe témoin ( P<0,05 ) . Lorsque les quantités totales d’analgésiques ont été calculées en équivalents de morphine , seuls les patients du groupe diclofénac avaient reçu moins d’analgésique que les témoins ( P<0,05 ) . La proportion de patients qui présentaient une augmentation postopératoire du niveau de créatinine ( 20 % et plus ) ne différait pas du groupe placebo aux autres groupes . Conclusion : Les anti-inflammatoires non stéroïdiens sont utiles en analgésique postopératoire chez des patients qui subissent un pontage aortocoronarien planifié . Le diclofénac semble offrir la meilleure analgésie en réduisant les besoins de morphine et d’autres analgésiques Under double-blind , crossover conditions , 43 women with primary dysmenorrhea received ketoprofen , ibuprofen , and placebo during three consecutive menstrual cycles . Pain intensity and pain relief were determined before and for 6 hours after the loading dose ( ketoprofen 150 mg , ibuprofen 800 mg ) and before and 2 hours after the maintenance dose ( ketoprofen 75 mg , ibuprofen 400 mg ) . Mean pain intensity difference and pain relief scores consistently indicated greater pain relief after the loading doses of ketoprofen and ibuprofen than after placebo . Significant ( P less than 0.05 ) mean changes that were measured by 13 indices of analgesia after the loading doses of both ketoprofen and ibuprofen indicated greater efficacy for the active treatments than for placebo . The patients ' global evaluations after the loading doses were significantly ( P less than 0.05 ) better for the active treatments than for placebo . The efficacy results were similar after the maintenance doses . The rates of a " good " to " excellent " response were 77 % for ketoprofen , 73 % for ibuprofen , and 35 % for placebo . Ketoprofen and ibuprofen were equally well tolerated , the most frequent adverse experiences being gastrointestinal symptoms for ketoprofen and central nervous system side effects for ibuprofen A double-blind parallel multi-centre study of 102 patients with rheumatoid arthritis ( RA ) was performed , comparing ibuprofen ( 1200 - 2400 mg daily ) and ketoprofen ( 150 - 300 mg daily ) a new non-steroidal , anti-inflammatory agent , over a three month period . Ketoprofen was well tolerated and shown to have comparable efficacy with ibuprofen . Longterm efficacy and tolerance studies are indicated In a multi-centre double-blind cross-over trial using the double-placebo technique , 55 patients with rheumatoid arthritis were treated for 10 days for each trial drug with ketoprofen ( 200 mg/day ) and ibuprofen ( 1200 mg/day ) . Both drugs induced a clinical ly and statistically significant improvement of all the symptoms studied , except for pain at night during ibuprofen administration . Ketoprofen displayed a therapeutic efficacy significantly superior to ibuprofen in five of the eight symptoms studied . Side-effects were recorded in 10 patients receiving ketoprofen ( one patient withdrew because of heartburn ) and in nine patients receiving ibuprofen Preoperative treatment with controlled-release ketoprofen or diclofenac was compared in 56 out- patients , for control of postoperative dental pain , following unilateral or bilateral surgical removal of lower third molars . Six patients were excluded due to non-compliance , leaving 50 evaluable patients . Patients were assessed by the dental surgeon , on the day of the operation and one week later , prior to removal of sutures . Additionally , patients completed a daily diary during the postoperative week . Following surgery , scores for grade d dental pain , consumption of paracetamol , incidence of dental bleeding , dysphagia , sleep disturbance and trismus were similar for the two treatment groups . However , median pain scores were consistently elevated in the diclofenac group over those seen with the ketoprofen group . The four adverse events reported were all minor and posed no problem to patient management A double-blind cross-over study of ketoprofen ( Orudis ) 150 mg daily and ibuprofen ( Brufen ) 1,200 mg daily was carried out in 35 out patients with rheumatoid arthritis . Results suggest that analgesic and anti-inflammatory activity of ketoprofen is superior to that of ibuprofen . Significantly greater pain relief ( P < 0·05 ) and reduction in joint circumference ( P < 0·01 ) was obtained with ketoprofen than with ibuprofen . Side effects of the drugs were comparable and not serious A comparative controlled study was carried out in 40 patients suffering from rheumatoid arthritis , osteoarthrosis or ankylosing spondylitis to assess the efficacy of ketoprofen and ibuprofen . Patients were allocated at r and om to receive either 100 mg ketoprofen twice daily or 400 mg ibuprofen 3-times daily over a period of 3 months . Subjective overall assessment s of symptoms , based on rating scale scores for pain , duration of morning stiffness and inflammation , showed that there was a greater , more rapid and more sustained improvement in those patients treated with ketoprofen . Measurements of inflamed joint size and of grip strength also improved more with ketoprofen than with ibuprofen . Side-effects , notably nausea , epigastric discomfort and abdominal pain , were more frequent and severe with ketoprofen , leading to the withdrawal of 2 patients in the early stage of the trial , and were probably related to the high dosage used . Three patients receiving ibuprofen needed 7 injections of ACTH to control their symptoms Eighteen patients with rheumatoid arthritis were treated for 3 months with controlled release ketoprofen ( Oruvail ) 100 mgm once daily ( 9 patients ) or diclofenac sodium ( Voltaren ) 25 mgm three times daily ( 9 patients ) . Patients were evaluated at the start of the study and at subsequent visits on days 28 , 56 and 84 . Clinical evaluation included assessment of severity and duration of morning stiffness and the severity of pain and Joint tenderness . Patients were instructed not to take any other nonsteroidal anti -Inflammatory drug , although paracetamol tablets were provided for pain relief if required . Over the study period patients receiving ketoprofen showed a significant reduction in severity of pain , Joint tenderness and morning stiffness . Patients receiving diclofenac sodium showed a significant decrease only In morning stiffness . No estimation of patient compliance or of consumption of paracetamol was made during the study . The incidence of side effects was similar with both drugs , and liver function tests , kidney function , electrolytes and haematology were not affected by drug treatment . Six patients withdrew from the study , three from each drug group . Both ketoprofen and diclofenac sodium were concluded to have beneficial therapeutic effects in patients with rheumatoid arthritis when administered at their minimum recommended dose levels Ninety patients with rheumatoid arthritis completed a double-blind crossover trial comparing fenoprofen , ibuprofen , ketoprofen , and naproxen . Fenoprofen and naproxen were slightly more effective than the other two drugs but there were striking individual variations in response . Groups of patients could be identified who preferred each of the four drugs . The commonest side effects were those related to the upper gastrointestinal tract ; these showed individual variation and seldom occurred with more than one or two of the drugs . Side effects were least common with ibuprofen and naproxen . Since naproxen combined greater effectiveness with a lower incidence of side effects it must be regarded as the first choice among these drugs . It may be necessary to try several drugs before finding the right one for a particular patient Output:

The results of the meta- analysis showed a statistically significant difference in efficacy in favour of ketoprofen . Heterogeneity for the analysed efficacy outcome was not statistically significant in any of the meta-analyses . The efficacy of orally administered ketoprofen in relieving moderate-severe pain and improving functional status and general condition was significantly better than that of ibuprofen and /or diclofenac

MS2_1shot520

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To assess the efficacy and safety of a copper-salicylate gel in osteoarthritis of the hip and knee . DESIGN R and omised , double-blind , placebo-controlled study . SETTING Rheumatology Clinic of St Vincent 's Hospital , Sydney , New South Wales ( a tertiary referral hospital ) , June 1993 to October 1994 . PATIENTS 116 patients with pain associated with osteoarthritis of the hip and /or knee ( diagnosed by criteria of the European League against Rheumatism ) , drawn from patients attending the Clinic or self-referred after newspaper advertisements . INTERVENTION Copper-salicylate or placebo gel ( 1.5 g ) applied twice daily to the forearm for four weeks . OUTCOME MEASURES Self- assessment of pain before the trial and after two and four weeks of treatment ; patient and investigator assessment s of efficacy ; additional analgesia required ; adverse reactions ; and withdrawal rates . RESULTS Pain scores at rest and on movement decreased in both the copper-salicylate and placebo groups by 13%-20 % . There was no significant difference between the two groups for decrease in pain score , patient and investigator efficacy ratings , number of patients requiring paracetamol for extra analgesia ( active , 77 % ; placebo , 71 % ) and average dose of paracetamol ( active , 555 mg/day ; placebo , 600 mg/day ) . Significantly more patients in the copper-salicylate group reported adverse reactions ( 83 % versus 52 % of the placebo group ) , most commonly skin reactions , and withdrew from the trial because of these reactions ( 17 % versus 1.7 % of the placebo group ) . CONCLUSION Copper-salicylate gel applied to the forearm was no better than placebo gel as pain relief for patients with osteoarthritis of the hip or knee , but produced significantly more skin rashes Objective : To determine the clinical effects of the treatment of lumbar disc herniation with herbal magnetic corsets . Design : A r and omized control trial . Setting : The outpatient and inpatient departments of the Rehabilitation Center of the West China Hospital . Patients : Sixty patients with clinical ly diagnosed lumbar disc herniation were included in the study . Interventions : Both groups received lumbar traction , medium frequency electrotherapy and massage , whereas the experimental group wore herbal magnetic corsets in addition . Main outcome measures : Pain and lumbar function were assessed before treatment and at one week , two weeks and four weeks after intervention . Results : Both groups reported improvements in pain and lumbar function after treatment ( P 0.05 or P 0.001 ) . However , the experimental group reported gradually increasing relief over time leading to a better curative effect than observed in the control group ( P 0.05 for visual analogue scale or P 0.001 for lumbar function ) . Conclusion : Herbal magnetic corsets can facilitate the reduction of pain caused by lumbar disc herniation and can improve lumbar function . This is a safe and effective non-operative therapeutic option for treatment of lumbar disc herniation Abstract Variability in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size Enelbin-Rheuma-ointment and a reference ointment were compared with regard to effectiveness in a double-blind trial in 100 patients with gonarthrosis , osteoarthrosis of the spine and humeroscapular periarthropathy . Both ointments showed good results regarding spontaneous pain , pain on pressure and motion , reduction of mobility , swelling and muscular tension . The success of treatment was statistically significantly better in the Enelbin-Rheuma-ointment treated patients Abstract This r and omized , double-blind study was design ed to evaluate the effectiveness of the topical cream Theraflex-TMJ ( NaBob/Rx , San Mateo , CA ) in patients with masseter muscle pain and temporom and ibular joint ( TMJ ) pain . Fifty-two subjects ( 5 males and 47 females ) were instructed to apply a cream over the afflicted masseter muscle(s ) or over the jaw joint(s ) twice daily for two weeks . Theraflex-TMJ cream was used by the experimental group , while a placebo cream was used by the control group . The means of pain ratings were calculated prior to the application of the cream ( baseline ) , after ten days of tx ( period 1 ) , and 15 days of tx ( period 2 ) days of treatment and five days after stopping the treatment ( follow-up ) . There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 ( p<0.01 ) , period 2 ( p<0.001 ) , and follow-up ( p<0.01 ) . For the control group , no significant differences were found between the different time periods ( p>0.05 ) . There was evidence of minor side effects such as skin irritation and /or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups . The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporom and ibular joint BACKGROUND An occlusive patch formulation containing 10 % methyl salicylate and 3 % l-menthol was recently approved by the US Food and Drug Administration for the treatment of mild to moderate pain . Despite widespread use of counterirritants , including methyl salicylate and menthol , for topical pain relief , published efficacy and safety data regarding the use of the agents alone or in combination are limited . OBJECTIVE The goal of this study was to determine the efficacy and safety profile of a patch containing 10 % methyl salicylate and 3 % l-menthol compared with a placebo patch in adult patients with mild to moderate muscle strain . METHODS Eligible patients were men or women aged > or=18 years with a clinical diagnosis of mild to moderate muscle strain . Patients were r and omly assigned to receive either 1 active patch or 1 placebo patch applied to the skin at the affected area ( ie , shoulder , upper back , upper arm , neck , calf , thigh , forearm , abdomen ) . Pain intensity was assessed on a 100-mm visual analog scale while at rest and with movement for 12 hours after patch application . The primary efficacy end point was the summed pain intensity difference score through 8 hours ( SPID8 ) with movement . Analyses included use of descriptive statistics and an ANOVA model . Safety data , including adverse events , and secondary efficacy end points were also evaluated . RESULTS A total of 208 patients ( 104 men , 104 women ; age range , 18 - 78 years ) were r and omized to 1 of 2 study groups ( 105 in the active-patch group [ mean age , 37.3 years ] , 103 in the placebo-patch group [ mean age , 38.1 years ] ) . The primary efficacy analysis ( SPID8 with movement ) indicated that patients receiving the active patch experienced significantly greater pain relief ( approximately 40 % ) than those patients receiving a placebo patch ( mean [ SD ] , 182.6 [ 131.2 ] vs 130.1 [ 144.1 ] ; P = 0.005 ) . Analysis of the per- protocol population also found significantly more relief ( P = 0.024 ) in the active-patch group ( 176.2 [ 131.4 ] ; n = 92 ) versus the placebo-patch group ( 130.2 [ 144.0 ] ; n = 96 ) . Statistical analysis of secondary efficacy measures supported the primary end-point results . The number of patients experiencing any type of adverse event was comparable between study groups ( active patch , 6.7 % [ 7 events ] ; placebo patch , 5.8 % [ 6 events ] ) . No serious adverse events were reported during the study . CONCLUSION A single , 8-hour application of a patch containing methyl salicylate and l-menthol provided significant relief of pain associated with mild to moderate muscle strain in these adult patients compared with patients receiving a placebo patch Twenty-five patients with symptomatic osteoarthritis ( OA ) of the knee were treated topically for one week with either 10 % trolamine salicylate cream or placebo cream in a r and omized double-blind crossover study . No significant difference was found in subjective or objective measures of pain relief between the treatment and control groups . Eight patients preferred " active " test cream , six preferred placebo , and 11 had no preference . No side effects were reported . Topically applied 10 % trolamine salicylate cream did not relieve the pain of OA of the knee any more than did placebo Forty patients with acute mechanical low-back pain were treated in a double-blind manner with either Rado-Salil ® or placebo for 14 days . Statistically significant improvements in spontaneous pain , muscular contracture and in both the patient 's and physician 's opinions occurred by day 3 . These improvements persisted at day 14 and , in addition , there were statistically significant improvements in the finger – floor distance and the degree of lumbar extension . Treatment with Rado-Salil ® also allowed significant reduction in the use of oral analgesics . Only a few localized transient side-effects , requiring no specific treatment , were observed In a r and omised , placebo-controlled , double-blind study with parallel group comparison , the efficacy and tolerability of topical treatment with a mucopolysaccharide polysulphate/salicylic acid cream was investigated in 156 patients with acute sprains of the knee or ankle joint . There was a more rapid reduction in pain on movement ( the main parameter ) in the active drug group compared with the placebo group . On day 9 after r and omisation the difference was highly significant . There were no adverse events in the active drug group & NA ; A data base of r and omised clinical trials ( RCTs ) in pain research published from 1950 to 1990 was created following an extensive literature search . By applying a refined MEDLINE search strategy from 1966 to 1990 and by h and ‐ search ing more than 1 000 000 pages of a total of 40 biomedical journals published during the period 1950–1990 , more than 8000 RCTs were identified . The RCTs were published in more than 800 journals and over 85 % appeared between 1976 and 1990 . If the trend of the last 15 years persists , a total of more than 15 000 RCTs will be published in pain relief by the year 2000 . A detailed description of methods to ensure efficient use of re sources during the identification , retrieval and management of the information in pain relief and other fields is given . Emphasis is made on the importance of refining MEDLINE search strategies , on the use of volunteers to h and ‐ search journals and on careful monitoring of each of the steps of the process . The potential uses of the data base to guide clinical and research decisions are discussed Acute low back pain is a very common condition in Western industrialised countries . In most cases analgesics or topical medications are prescribed at first encounter with the general practitioner ( GP ) . The aim of this study was to investigate whether the homeopathic gel Spiroflor SRL gel ( SRL ) is equally effective and better tolerated than Cremor Capsici Compositus FNA ( CCC ) in patients with acute low back pain . A multi-centre , r and omised , double-blind , controlled clinical trial was conducted in the practice s of 19 GPs in the districts of Bristol and Manchester , UK . One hundred and sixty-one subjects suffering from acute low back pain were treated for one week either with SRL or with CCC . Pain was scored on a 100 mm visual analogue scale ( VAS ) . Main efficacy parameter VAS reduction was compared between treatments . Evaluation of safety was primarily based on the number of subjects with adverse events ( AEs ) , withdrawals due to an AE and adverse drug Output:

In both categories there were a number of factors might have influenced the results but sensitivity analysis was limited because of the small number of studies and participants .For both acute and chronic painful conditions any evidence of efficacy came from the older , smaller studies , while the larger , more recent studies showed no effect . The evidence does not support the use of topical rubefacients containing salicylates for acute injuries or chronic conditions . They seem to be relatively well tolerated in the short-term , based on limited data . The amount and quality of the available data mean that uncertainty remains about the effects of salicylate-containing rubefacients

MS2_1shot521

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Genotype scores that predict relevant clinical outcomes may detect other disease features and help direct prevention efforts . We report data that vali date a previously established v1.0 smoking cessation quit success genotype score and describe striking differences in the score in individuals who display differing developmental trajectories of use of common addictive substances . In a cessation study , v1.0 genotype scores predicted ability to quit with P=0.00056 and area under receiver-operating characteristic curve 0.66 . About 43 % vs 13 % quit in the upper vs lower genotype score terciles . Latent class growth analyses of a developmentally assessed sample identified three latent classes based on substance use . Higher v1.0 scores were associated with ( a ) higher probabilities of participant membership in a latent class that displayed low use of common addictive substances during adolescence ( P=0.0004 ) and ( b ) lower probabilities of membership in a class that reported escalating use ( P=0.001 ) . These results indicate that : ( a ) we have identified genetic predictors of smoking cessation success , ( b ) genetic influences on quit success overlap with those that influence the rate at which addictive substance use is taken up during adolescence and ( c ) individuals at genetic risk for both escalating use of addictive substances and poor abilities to quit may provide especially urgent focus for prevention efforts Purpose : A new generation of molecularly targeted agents is entering the definitive stage of clinical evaluation . Many of these drugs benefit only a subset of treated patients and may be overlooked by the traditional , broad- eligibility approach to r and omized clinical trials . Thus , there is a need for development of novel statistical methodology for rapid evaluation of these agents . Experimental Design : We propose a new adaptive design for r and omized clinical trials of targeted agents in setting s where an assay or signature that identifies sensitive patients is not available at the outset of the study . The design combines prospect i ve development of a gene expression – based classifier to select sensitive patients with a properly powered test for overall effect . Results : Performance of the adaptive design , relative to the more traditional design , is evaluated in a simulation study . It is shown that when the proportion of patients sensitive to the new drug is low , the adaptive design substantially reduces the chance of false rejection of effective new treatments . When the new treatment is broadly effective , the adaptive design has power to detect the overall effect similar to the traditional design . Formulas are provided to determine the situations in which the new design is advantageous . Conclusion : Development of a gene expression – based classifier to identify the subset of sensitive patients can be prospect ively incorporated into a r and omized phase III design without compromising the ability to detect an overall effect The authors present results of a r and omized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation . Adult smokers ( N = 362 ) received open-label treatment ( 11 weeks ) that combined relapse prevention training , bupropion SR , and nicotine patch followed by extended treatment ( 14 weeks ) with bupropion SR or matching placebo . Abstinence percentages were relatively high ( week 11 : 52 % ; week 25 : bupropion , 42 % ; placebo , 38 % ; week 52 : bupropion , 33 % ; placebo , 34 % ) , but bupropion SR did not surpass placebo . Gender and baseline craving level were identified as significant , independent moderators of treatment response . Men were more likely to abstain than women ( week 11 : 59 % vs. 43 % , p = .001 ; week 25 : 48 % vs. 31 % , p = .001 ; week 52 : 39 % vs. 27 % , p = .01 ) . Because most smokers suffer relapse with any current cessation treatment , the comparatively high abstinence percentages achieved in this trial are of interest Extending a previous finding of an association between functional genetic variation in the mu-opioid receptor gene and response to nicotine replacement therapy , we explored the role of genetic variants in two genes encoding mu-opioid-receptor-interacting proteins , namely ARRB2 and HINT1 . Participants were 374 smokers treated for nicotine dependence with either transdermal nicotine or nicotine nasal spray for 8 weeks in an open-label r and omized trial . In a logistic regression model controlling for OPRM1 genotype , treatment type , and other covariates , we found no significant main effect of ARRB2 genotype on abstinence at either end of treatment or 6-month follow-up . Participants with the HINT1 TT genotype had significantly higher abstinence rates at 6-month follow-up , but this may not be a pharmacogenetic effect , given that the participants were drug free during this time . Haplotype analysis did not reveal any significant associations for either gene . We found an interaction of ARRB2 and OPRM1 genotype on abstinence at 6 months that approached significance ; however , interpretation of this finding is limited by the small number of participants with the minor alleles for both genes . Although these data do not provide support for the role of genetic variation in these mu-opioid-receptor-interacting proteins and smoking cessation , further exploration of opioid pathway genes in larger prospect i ve pharmacogenetic trials may be warranted Stopping smoking is difficult even with treatment . Many patients prescribed pharmacologic treatments for smoking cessation experience side effects or lack of efficacy . We performed a pharmacogenetic study of the efficacy and tolerability of bupropion and transdermal nicotine ( TN ) , two treatments for smoking cessation . Sample s were drawn from two studies . In the first study ( Maintenance 1 , MT1 ) , 301 smokers received bupropion plus TN for 11 weeks , followed by 14 weeks of placebo or bupropion . In the second study ( MT2 ) , 276 smokers received bupropion and TN for 8 weeks . We focused on eight SNPs in the 15q24 region , which contains the genes for the nicotinic cholinergic receptor subunits CHRNA5 , CHRNA3 , and CHRNB4 , and has previously been implicated in nicotine addiction and smoking cessation . Analyses of baseline smoking quantity ( SQ ) identified an association between SQ and both the functional CHRNA5 SNP rs16969968 ( D398N ) and the CHRNA3 SNP rs1051730 ( Y215Y ) in a combined cohort containing MT1 and MT2 . An association between SQ and ethnicity was also identified in the combined cohort . Pharmacogenetic analysis showed a significant association between rs8192475 ( R37H ) in CHRNA3 and both higher craving after quitting and increased withdrawal symptoms over time in MT2 . Two markers for point prevalence abstinence , CHRNA5 SNP rs680244 and CHRNB4 SNP rs12914008 , were also identified in MT2 , with the strongest findings at week 52 . These results provide further support for the role of the CHRNA5/A3/B4 subunits in determining number of cigarettes smoked and response to smoking cessation therapy . © 2011 Wiley‐Liss , We conducted gender-stratified analyses on a systems-based c and i date gene study of 53 regions involved in nicotinic response and the brain — reward pathway in two r and omized clinical trials of smoking cessation treatments ( placebo , bupropion , transdermal and nasal spray nicotine replacement therapy ) . We adjusted P-values for multiple correlated tests , and used a Bonferroni-corrected α-level of 5 × 10−4 to determine system-wide significance . Four single-nucleotide polymorphisms ( rs12021667 , rs12027267 , rs6702335 , rs12039988 ; r2>0.98 ) in erythrocyte membrane protein b and 4.1 ( EPB41 ) had a significant male-specific marginal association with smoking abstinence ( odds ratio (OR)=0.5 ; 95 % confidence interval ( CI ) : 0.3–0.6 ) at end of treatment ( adjusted P<6 × 10−5 ) . rs806365 in cannabinoid receptor 1 ( CNR1 ) had a significant male-specific gene – treatment interaction at 6-month follow-up ( adjusted P=3.9 × 10−5 ) ; within males using nasal spray , rs806365 was associated with a decrease in odds of abstinence ( OR=0.04 ; 95 % CI : 0.01–0.2 ) . While the role of CNR1 in substance abuse has been well studied , we report EPB41 for the first time in the nicotine literature Purpose : Many anticancer therapies benefit only a subset of treated patients and may be overlooked by the traditional broad eligibility approach to design phase III clinical trials . New biotechnologies such as microarrays can be used to identify the patients that are most likely to benefit from anticancer therapies . However , due to the high-dimensional nature of the genomic data , developing a reliable classifier by the time the definitive phase III trail is design ed may not be feasible . Experimental Design : Previously , Freidlin and Simon ( Clinical Cancer Research , 2005 ) introduced the adaptive signature design that combines a prospect i ve development of a sensitive patient classifier and a properly powered test for overall effect in a single pivotal trial . In this article , we propose a cross-validation extension of the adaptive signature design that optimizes the efficiency of both the classifier development and the validation components of the design . Results : The new design is evaluated through simulations and is applied to data from a r and omized breast cancer trial . Conclusion : The cross-validation approach is shown to considerably improve the performance of the adaptive signature design . We also describe approaches to the estimation of the treatment effect for the identified sensitive sub population . Clin Cancer Res ; 16(2 ) ; INTRODUCTION We evaluated chr6q25.3 organic cation transporter gene ( SLC22A1 , SLC22A2 , SLC22A3 ) variation and response to smoking cessation therapies . The corresponding proteins are low-affinity transporters of choline , acetylcholine and monoamines , and smoking cessation pharmacotherapies expressed in multiple tissues . METHODS We selected 7 common polymorphisms for mega-regression analysis . We assessed additive model association of polymorphisms with 7-day point prevalence abstinence overall and by assigned pharmacotherapy at end of treatment and at 6 months among European-ancestry participants of 7 r and omized controlled trials adjusted for demographic , population genetic , and trial covariates . RESULTS Initial results were obtained in 6 trials with 1,839 participants . Nominally statistically significant associations of 2 SLC22A2 polymorphisms were observed : ( 1 ) with rs316019 at 6 months , overall ( [ c.808T > G ; p . Ser270Ala ] , OR = 1.306 , 95 % CI = 1.034 - 1.649 , p = .025 ) , and among those r and omized to nicotine replacement therapy ( NRT ) ( OR = 1.784 , 95 % CI = 1.072 - 2.970 , p = .026 ) ; and ( 2 ) with rs316006 ( c.1502 - 529A > T ) among those r and omized to varenicline ( OR = 1.420 , 95 % CI = 1.038 - 1.944 , p = .028 , OR = 1.362 , 95 % CI = 1.001 - 1.853 , p = .04 ) at end of treatment and 6 months . Individuals r and omized to NRT from a seventh trial were genotyped for rs316019 ; rs316019 was associated with a nominally statistically significant effect on abstinence overall at 6 months among 2,233 participants ( OR = 1.249 , 95 % CI = 1.007 - 1.550 , p = .043 ) . CONCLUSIONS The functional OCT2 Ser270Ala polymorphism is nominally statistically significantly associated with abstinence among European-ancestry treatment-seeking smokers after adjustments for pharmacotherapy , demographics , population genetics , and without adjustment for multiple testing of 7 SNPs . Replication of these preliminary findings in additional r and omized controlled trials of smoking cessation therapies and from multiple continental population s would describe another pharmacogenetic role for SLC22A2/OCT2 INTRODUCTION The α4β2 nicotinic receptor is of central importance in tobacco dependence , while the homomeric α7 receptor may also play a role . In this c and i date gene study , we examine the association between 8 single nucleotide polymorphisms ( SNPs ) in genes coding for nicotinic acetylcholine receptor subunits α4 ( rs1044396 , rs2273504 , rs2236196 , and rs2273502 ) , α7 ( rs2133965 and rs4779969 ) , and β2 ( rs2072660 and rs2072661 ) and smoking abstinence in a cohort of quitters enrolled in a clinical trial of behavioral support . METHODS Data were obtained from the " Patch in Practice " study , involving 925 smokers in the United Kingdom . All participants were given an 8 Output:

AUTHORS ' CONCLUSIONS We did not identify widespread differential treatment effects of pharmacotherapy based on genotype . Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT . Although we found evidence of superior NRT efficacy for NMR slow versus normal metabolisers , because of the lack of heterogeneity between NMR groups , we can not conclude that NRT is more effective for slow metabolisers .

MS2_1shot522

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background A protective effect on injury risk in youth sports through neuromuscular warm-up training routines has consistently been demonstrated . However , there is a paucity of information regarding the quantity and quality of coach-led injury prevention programmes and its impact on the physical performance of players . Objective The aim of this cluster-r and omised controlled trial was to assess whether different delivery methods of an injury prevention programme ( FIFA 11 + ) to coaches could improve player performance , and to examine the effect of player adherence on performance and injury risk . Method During the 2011 football season ( May – August ) , coaches of 31 tiers 1–3 level teams were introduced to the 11 + through either an unsupervised website or a coach-focused workshop with and without additional on-field supervisions . Playing exposure , adherence to the 11 + , and injuries were recorded for female 13-year-old to 18-year-old players . Performance testing included the Star Excursion Balance Test ( SEBT ) , single-leg balance , triple hop and jumping-over-a-bar tests . Results Complete preseason and postseason performance tests were available for 226 players ( 66.5 % ) . Compared to the unsupervised group , single-leg balance ( OR=2.8 ; 95 % CI 1.1 to 4.6 ) and the anterior direction of the SEBT improved significantly in the onfield supervised group of players ( OR=4.7 ; 95 % CI 2.2 to 7.1 ) , while 2-leg jumping performance decreased ( OR=−5.1 ; 95 % CI −9.9 to −0.2 ) . However , significant improvements in 5 of 6 reach distances in the SEBT were found , favouring players who highly adhered to the 11 + . Also , injury risk was lower for those players ( injury rate ratio , IRR=0.28 , 95 % CI 0.10 to 0.79 ) . Conclusions Different delivery methods of the FIFA 11 + to coaches influenced players ’ physical performance minimally . However , high player adherence to the 11 + result ed in significant improvements in functional balance and reduced injury risk Female soccer players are three times more likely to suffer a non-contact anterior cruciate ligament ( ACL ) tear compared with male soccer players . Several ACL injury prevention programs have been developed and are used to reduce injury risk . However , to date there is limited information on how such programs affect physical performance . The aim of this r and omized controlled study was to investigate the effects of the Prevent Injury Enhance Performance ( PEP ) program in adolescent female soccer players . Four soccer teams were r and omly assigned to an intervention ( PEP ) or control ( CON ) group and assessed at baseline , 6 weeks , and 12 weeks on linear sprinting , countermovement jump ( CMJ ) , and two agility tests . A mixed model factorial ANOVA with repeated measures was used to assess for treatment effects on the dependent variables . Improvements in 27.3 and 36.6 m sprint times ( < 0.10 s ) were evident during the first 6 weeks for PEP , but reverted back to baseline values by 12 weeks ; there were no changes for 9.1 or 18.2 m sprint times in either group . There was no change in the CMJ height for PEP ; however , there was a decrement at 6 and 12 weeks compared with baseline in CON . Performance on the Illinois and pro-agility tests declined in both groups . Our findings demonstrate that improvements in linear sprint performance were small and transient in adolescent female soccer players , and that there was no benefit of the PEP program on CMJ or agility performance . ACL injury prevention programs design ed as a structured warm-up routine seem to lack the necessary stimulus to enhance athletic performance Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose The objective of the present r and omised controlled trial was to study the effect of a neuromuscular warm-up programme on performance tests in youth female football . Methods Four youth female football teams with players aged 12–16 years were r and omised into an intervention group and control group . The intervention was a 15-min neuromuscular warm-up programme carried out twice a week during the 11-week study period . Baseline and follow-up measurements of performance were made indoors and included the star excursion balance test , a countermovement jump test , a triple-hop for distance test , a modified Illinois agility test , and 10- and 20-m sprint tests . Results Fifty-two players ( intervention 28 ; control 24 ) took part in baseline measurements , and after dropout , 41 players ( intervention 23 ; control 18 ) were included for analysis . Minor positive changes were seen in the control group compared to the intervention group for a sub-score of the star excursion balance test ( P < 0.05 ) and in the modified Illinois agility test ( P < 0.05 ) . No improvement was seen in the intervention group from baseline to follow-up . Conclusions The study showed that a neuromuscular warm-up programme carried out during 11 weeks did not improve performance in youth female football . This could indicate that the programme does not contain sufficient stimulus to improve performance . A low player attendance at training sessions , and low specificity between exercises in the warm-up programme and the evaluated performance tests may also contribute to the lack of effect . Level of evidence Abstract Ramírez-Campillo , R , Álvarez , C , Henríquez-Olguín , C , Baez , EB , Martínez , C , And rade , DC , and Izquierdo , M. Effects of plyometric training on endurance and explosive strength performance in competitive middle- and long-distance runners . J Strength Cond Res 28(1 ) : 97–104 , 2014—The purpose of this study was to examine the effect of a short-term plyometric training program on explosive strength and endurance performance in highly competitive middle- and long-distance runners . Athletes were r and omly assigned to a control group ( CG , n = 18 , 12 men ) and an explosive strength training group ( TG , n = 18 , 10 men ) . Drop jump ( DJ ) from 20 ( DJ20 ) and 40 cm ( DJ40 ) , countermovement jump with arms ( CMJA ) , 20-m sprint time , and 2.4-km endurance run time test were carried out before and after 6 weeks of explosive strength training . Also , the combined st and ardized performance ( CSP ) in the endurance and explosive strength test was analyzed . After intervention , the CG did not show any significant change in performance , whereas the TG showed a significant reduction in 2.4-km endurance run time ( −3.9 % ) and 20-m sprint time ( −2.3 % ) and an increase in CMJA ( + 8.9 % ) , DJ20 ( + 12.7 % ) , and DJ40 ( 16.7 % ) explosive performance . Strength training group also exhibited a significant increase in CSP , although the CG showed significant reduction . We conclude that properly programmed concurrent explosive strength and endurance training could be advantageous for middle- and long-distance runners in their competitive performance , especially in events characterized by sprinting actions with small time differences at the end of the race Purpose The study investigated the effects of FIFA 11 + and HarmoKnee , both being popular warm-up programs , on proprioception , and on the static and dynamic balance of professional male soccer players . Methods Under 21 year-old soccer players ( n = 36 ) were divided r and omly into 11 + , HarmoKnee and control groups . The programs were performed for 2 months ( 24 sessions ) . Proprioception was measured bilaterally at 30 ° , 45 ° and 60 ° knee flexion using the Biodex Isokinetic Dynamometer . Static and dynamic balances were evaluated using the stork st and test and Star Excursion Balance Test ( SEBT ) , respectively . Results The proprioception error of dominant leg significantly decreased from pre- to post-test by 2.8 % and 1.7 % in the 11 + group at 45 ° and 60 ° knee flexion , compared to 3 % and 2.1 % in the HarmoKnee group . The largest joint positioning error was in the non-dominant leg at 30 ° knee flexion ( mean error value = 5.047 ) , ( p<0.05 ) . The static balance with the eyes opened increased in the 11 + by 10.9 % and in the HarmoKnee by 6.1 % ( p<0.05 ) . The static balance with eyes closed significantly increased in the 11 + by 12.4 % and in the HarmoKnee by 17.6 % . The results indicated that static balance was significantly higher in eyes opened compared to eyes closed ( p = 0.000 ) . Significant improvements in SEBT in the 11 + ( 12.4 % ) and HarmoKnee ( 17.6 % ) groups were also found . Conclusion Both the 11 + and HarmoKnee programs were proven to be useful warm-up protocol s in improving proprioception at 45 ° and 60 ° knee flexion as well as static and dynamic balance in professional male soccer players . Data from this research may be helpful in encouraging coaches or trainers to implement the two warm-up programs in their soccer teams Purpose Injury prevention effects of neuromuscular training have been partly attributed to postural control adaptations . Uncertainty exists regarding the magnitude of these adaptations and on how they can be adequately monitored . The objective was to determine the time course of neuromuscular training effects on functional , dynamic and static balance measures . Methods Thirty youth ( 14.9 ± 3 years ) field hockey athletes were r and omised to an intervention or control group . The intervention included a 20-min neuromuscular warm-up program performed twice weekly for 10 weeks . Balance assessment s were performed at baseline , week three , week six and post-intervention . They included the star excursion balance test ( SEBT ) , balance error scoring system ( BESS ) , jump-l and ing time to stabilization ( TTS ) and center of pressure ( COP ) sway velocity during single-leg st and ing . Results No baseline differences were found between groups in demographic data and balance measures . Adherence was at 86 % . All balance measures except the medial – lateral TTS improved significantly over time ( p < 0.05 ) in both groups . Significant group by time interactions were found for the BESS score ( p < 0.001 ) . The intervention group showed greater improvements ( 69.3 ± 10.3 % ) after 10 weeks in comparison to controls ( 31.8 ± 22.1 % ) . There were no significant group by time interactions in the SEBT , TTS and COP sway velocity . Conclusions Neuromuscular training was effective in improving postural control in youth team athletes . However , this effect was not reflected in all balance measures suggesting that the neuromuscular training did not influence all dimensions of postural control . Further studies are needed to confirm the potential of specific warm-up programs to improve postural control STUDY DESIGN Controlled cohort repeated- measures experimental design . OBJECTIVES To determine if a neuromuscular training program ( NMTP ) focused on core stability and lower extremity strength would affect performance on the star excursion balance test ( SEBT ) . We hypothesized that NMTP would improve SEBT performance in the experimental group and there would be no side-to-side differences in either group . BACKGROUND The SEBT is a functional screening tool that is used to assess dynamic stability , monitor rehabilitation progress , assess deficits following an injury , and identify athletes at high risk for lower extremity injury . The SEBT requires lower extremity coordination , balance , flexibility , and strength . METHODS Twenty uninjured female soccer players ( 13 experimental , 7 control ) participated . Players trained together as a team , so group allocation was not r and omized . The SEBT was administered prior to and following 8 weeks of NMTP in the experimental group and 8 weeks of no NMTP in the control group . A 3-way mixed-model ANOVA was used to determine the effect of group ( experimental versus control ) , training ( pretraining versus posttraining ) , and limb ( right versus left ) . RESULTS After participation in a NMTP , subjects demonstrated a significant improvement in the SEBT composite score ( mean ± SD ) on the right limb ( pretraining , 96.4 % ± 11.7 % ; posttraining , 104.6 % ± 6.1 % ; P = .03 ) and the left limb ( pretraining , 96.9 % ± 10.1 % ; posttraining , 103.4 % ± 8.0 % ; P = .04 ) . The control group had no change on the SEBT composite score for the right ( pretraining , 95.7 % ± 5.2 % ; posttraining , 94.4 % ± 5.2 % ; P = .15 ) or the left ( 97.4 % ± 7.2 % ; 93.6 % ± 5.0 % ; P = .09 ) limb . Further analysis identified significant improvement for the SEBT in the posterolateral direction on both the right ( P = .008 ) and left ( P = .040 ) limb and the posteromedial direction of the left limb ( P = .028 ) in the experimental group . CONCLUSION Female soccer players demonstrated an improved performance on the SEBT after NMTP that focused on core stability and lower extremity strength Objective To examine the effect of a comprehensive warm-up programme design ed to reduce the risk of injuries in female youth football . Design Cluster r and omised controlled trial with clubs as the unit of r and omisation . Setting 125 football clubs from the south , east , and middle of Norway ( 65 clusters in the intervention group ; 60 in the control group ) followed for one league season ( eight months ) . Output:

Sports-specific IPPs have the strongest influence on most performance indices based on the significant improvement versus control groups .

MS2_1shot523

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Undernutrition is a major concern for Myanmar children with low exclusive breastfeeding rate ( 24 % ) . A formative study was conducted to explore the perceptions and practice s relating to exclusive breastfeeding , and barriers and facilitators to using mobile communications for exclusive breastfeeding counselling . The results inform the design of a r and omized control trial to promote exclusive breastfeeding practice s among Myanmar mothers . Methods We conducted twenty in-depth interviews with pregnant women and accompanying family members attending an antenatal clinic at the Central Women ’s Hospital , Yangon , seven key-informant interviews and one focus group discussion with fifteen service providers such as nurses , doctors , managers and staff from the National Nutrition Centre , Department of Health , United Nations Children ’s Fund International and National Non-Government Organizations and Ooredoo , a private mobile company . Results Widespread practice s of feeding water , honey , infant formula and semi-solid food were reported to be existed in the community before the child reaches four months , mostly influenced by gr and mothers from both sides . All couples knew breast milk was good for baby and intended to breastfeed , though limited underst and ing of the term exclusive breastfeeding was reported . Perception that breast milk alone was not sufficient to provide all nutrients needed for the first six months of baby ’s life , mother had insufficient milk supply or breast problems , mother ’s back to work and gr and mothers ’ influence emerged as barriers to breastfeed exclusively for six months . All women knew how to make basic phone calls , majority could read mobile text message in Burmese and possess mobile phones while a few of them shared phones with their husb and s. All couples preferred to receive text messages 2–3 times per week in the evening . Institutional staff suggested messages to be simple , easily underst and able and culturally appropriate . Perceived barriers included limited mobile network coverage , affordability of mobile h and set and phone bills , literacy and community familiarity with text messages . All respondents welcomed the idea of planned intervention . Conclusion We incorporated findings to develop messages and determine the modality , inclusion criteria and tailored with gestation and child age , to be delivered in the r and omized controlled trial intervention This r and omized behavioral trial examined whether youth living with HIV ( YLH ) receiving cell-phone support with study funded phone plans , demonstrated improved adherence and viral control during the 24 week intervention and 24 weeks post-intervention compared to controls . Monday through Friday phone calls confirmed medications were taken , provided problem-solving support , and referred to services to address adherence barriers . Of 37 participants ( ages 15–24 ) , 62 % were male and 70 % were African American . Self-reported adherence was significantly higher in the intervention group compared to the control at 24 and 48 weeks for the past month ( P = 0.007 ) and log 10 HIV VL was significantly lower at both 24 weeks ( 2.82 versus 4.52 P = 0.002 ) and 48 weeks ( 3.23 versus 4.23 P = 0.043 ) . Adherence and viral load showed medium to large effect sizes across the 48 week study . This is the first study to demonstrate sustained clinical ly significant reductions in HIV VL using youth friendly technology . ResumenEste ensayo de comportamiento aleatorio examinó si los jóvenes que viven con el VIH ( YLH ) reciben apoyo por celular con el estudio financiado de teléfono , se demostró un mejor cumplimiento y control viral durante la intervención de 24 semanas y 24 semanas después de la intervención en comparación con los controles . De Lunes a Viernes las llamadas telefónicas confirmaron los medicamentos , apoyaron la resolución de problemas , y se refirió a los servicios para hacer frente a las barreras de adherencia . De los 37 participantes ( siglos 15–24 ) , el 62 % eran hombres y el 70 % eran afroamericanos . Adherencia auto-reportada fue significativamente mayor en el grupo de intervención en comparación con el control a las 24 y 48 semanas del mes pasado ( P = 0.007 ) y el log 10 VL VIH fue significativamente menor en ambos 24 semanas ( 2.82 versus 4.52 P = 0.002 ) y 48 semanas ( 3.23 versus 4.23 P = 0.043 ) . La adhesión y la carga viral mostraron medianas y gr and es tamaños del efecto en todo el estudio de 48 semanas . Este es el primer estudio que demuestra descensos importantes de la VL VIH utiliz and o tecnología amigable para la juventud HIV-positive adolescents and young adults often experience suboptimal medication adherence , yet few interventions to improve adherence in this group have shown evidence of efficacy . We conducted a r and omized trial of a two-way , personalized daily text messaging intervention to improve adherence to antiretroviral therapy ( ART ) among N = 105 poorly adherent HIV-positive adolescents and young adults , ages 16–29 . Adherence to ART was assessed via self-reported visual analogue scale ( VAS ; 0–100 % ) at 3 and 6-months for mean adherence level and proportion ≥90 % adherent . The average effect estimate over the 6-month intervention period was significant for ≥90 % adherence ( OR = 2.12 , 95 % CI 1.01–4.45 , p < .05 ) and maintained at 12-months ( 6 months post-intervention ) . Satisfaction scores for the intervention were very high . These results suggest both feasibility and initial efficacy of this approach . Given study limitations , additional testing of this intervention as part of a larger clinical trial with objective and /or clinical outcome measures of adherence is warranted Social media technologies have become increasingly useful tools for research -based interventions . However , participants and social media users have expressed ethical concerns with these studies , such as risks and benefits of participation , as well as privacy , confidentiality , and informed consent issues . This study was design ed to follow up with and assess experiences and perceptions of ethics-related issues among a sample of 211 men who have sex with men who participated in the Harnessing Online Peer Education ( HOPE ) Peru study , a r and omized controlled HIV prevention intervention conducted in Peru . We found that after adjusting for age , highest educational attainment , race , sexual orientation , and prior HIV research experience , participants in the intervention group were more likely than those in the control group to have safe sex ( p = 0.0051 ) and get tested for HIV regularly ( p = 0.0051 ) . As a result of their participation , those in the intervention group benefited more positively than participants in the control group in improving HIV care ( p = 0.0077 ) and learning where to receive sexual health services ( p = 0.0021 ) . Participants in the intervention group expressed higher levels of comfort than those in the control group in joining and seeing other people in the Facebook group ( p = 0.039 ) , seeing other people ’s posts ( p = 0.038 ) and having other group members talk to them online ( p = 0.040 ) . We discuss the implication s of these results as they relate to social media-based HIV research Background Poor adherence to antiretroviral treatment has been a public health challenge associated with the treatment of HIV . Although different adherence-supporting interventions have been reported , their long term feasibility in low income setting s remains uncertain . Thus , there is a need to explore sustainable context ual adherence aids in such setting s , and to test these using rigorous scientific design s. The current ubiquity of mobile phones in many re source -constrained setting s , make it a context ually appropriate and relatively low cost means of supporting adherence . In India , mobile phones have wide usage and acceptability and are potentially feasible tools for enhancing adherence to medications . This paper presents the study protocol for a trial , to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India . Methods / Design 600 treatment naïve patients eligible for first-line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India . Patients will be r and omized into control and intervention arms . The control arm will receive the st and ard of care ; the intervention arm will receive the st and ard of care plus mobile phone reminders . Each reminder will take the form of an automated call and a picture message . Reminders will be delivered once a week , at a time chosen by the patient . Patients will be followed up for 24 months or till the primary outcome i.e. virological failure , is reached , whichever is earlier . Self-reported adherence is a secondary outcome . Analysis is by intention-to-treat . A cost-effectiveness study of the intervention will also be carried out . Discussion Stepping up telecommunications technology in re source -limited healthcare setting s is a priority of the World Health Organization . The trial will evaluate if the use of mobile phone reminders can influence adherence to first-line antiretrovirals in an Indian context .Trial Registration Trial registration : IS RCT N79261738 Background Despite the increasing breast cancer incidence and mortality rates , Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States . Mobile health ( mHealth ) , defined as the delivery of health care information or services through mobile communication devices , has been utilized to successfully improve a variety of health outcomes . Objective This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women , an underserved community . Methods Using a r and omized controlled trial design , 120 Korean American women aged 40 to 77 years were recruited and r and omly assigned to either the mMammogram intervention group ( n=60 ) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group ( n=60 ) to receive a printed brochure . Outcome measures included knowledge , attitudes , and beliefs about breast cancer screening , readiness for mammography , and mammogram receipt . The feasibility and acceptability of the mMammogram intervention was also assessed . Results The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines ( P=.01 ) . The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group . A significantly higher proportion of women who received the mMammogram intervention ( 75 % , 45/60 ) completed mammograms by the 6-month follow-up compared with the control group ( 30 % , 18/60 ; P<.001 ) . In addition , the intervention group rated satisfaction with the intervention ( P=.003 ) , effectiveness of the intervention ( P<.001 ) , and increase of knowledge on breast cancer and screenings ( P=.001 ) significantly higher than the control group . Conclusions A mobile phone app – based intervention combined with health navigator service was a feasible , acceptable , and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women . A flexible , easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit population s that bear disproportionate cancer burdens . Trial Registration Clinical trials.gov NCT01972048 ; https:// clinical trials.gov/show/NCT01972048 ( Archived by WebCite at https:// clinical trials.gov/archive/NCT01972048/2013_10_29 & NA ; Patient engagement in care and adherence to medication are critical to achieving the full benefits of antiretroviral therapy ( ART ) among people with HIV infection . A r and omized controlled trial in Kenya , WelTelKenya1 , showed that an interactive mobile phone text‐messaging intervention can improve adherence and viral load suppression . We conducted a pilot study to adapt the WelTel intervention for HIV‐infected clients ( n = 25 ) at an HIV clinic in Vancouver , British Columbia . Between April and June 2012 , we recruited five participants from five groups : youth ( 14–24 years ) , mature ( ≥50 years ) , English as a second language , remote ( ≥3 hours travel time to clinic ) , and nonsuppressed ( CD4 + T cell count < 200 cells/mm3 and viral load ≥250 copies/mL on two consecutive occasions ) . Participants described the intervention as a useful way to communicate with health care providers , thus increasing the ability to access services , report side effects , and attend appointments BACKGROUND Oral contraceptive ( OC ) knowledge deficits may contribute to OC discontinuation . We examined the effect of an innovative educational intervention on young women 's OC knowledge . STUDY DESIGN As part of a r and omized trial evaluating the impact of text message reminders on OC continuation , we assessed OC knowledge in 659 women ages 13 - 25 years . Women received routine care or routine care plus 6 months of daily educational text messages . We administered a comprehensive 41-item OC knowledge survey at baseline and 6 months . RESULTS Mean OC knowledge scores improved over time for all women ( baseline 22.8 , 56 % correct versus 24.7 , 60 % at 6 months ) , including knowledge of OC 's mechanisms of action ( p=.004 ) , effectiveness ( p<.001 ) , side effects ( p=.03 ) and benefits ( p<.001 ) . Mean 6-month scores were greater in the intervention ( 25.5 ) than the control group (23.7)(p<.001 ) . In multivariable linear regression models , the text message intervention most strongly predicted OC knowledge ( β=1 Output:

Our synthesis showed that clients ' experiences of these types of programmes were mixed . However , clients also pointed to problems when using these programmes . The cost of messages could also be a problem , and many thought that messages should be free of charge ( high confidence ) . Language issues as well as skills in reading , writing , and using mobile phones could also be a problem ( moderate confidence ) . Clients dealing with stigmatised or personal health conditions such as HIV , family planning , or abortion care were also concerned about privacy and confidentiality ( high confidence ) . Some clients suggested strategies to deal with these issues , such as using neutral language and tailoring the content , timing , and frequency of messages ( high confidence ) . Clients wanted messages at a time and frequency that was convenient for them ( moderate confidence ) . Clients ' views about who sent the digital health communication could influence their views of the programme ( moderate confidence ) . Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified , although this may have been a reporting issue . Authors ' conclusions Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices .

MS2_1shot524

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Although the Dietary Approaches to Stop Hypertension ( DASH ) diet is an accepted nonpharmacologic treatment for hypertension , little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure ( BP ) . OBJECTIVE Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinical ly meaningful BP reductions . DESIGN Ancillary study of the ENCORE ( Exercise and Nutrition Interventions for Cardiovascular Health ) trial -- a 16-week r and omized clinical trial of diet and exercise . PARTICIPANTS / SETTING Participants included 144 sedentary , overweight , or obese adults ( body mass index 25 to 39.9 ) with high BP ( systolic 130 to 159 mm Hg and /or diastolic 85 to 99 mm Hg ) . INTERVENTION Patients were r and omized to one of three groups : DASH diet alone , DASH diet plus weight management , and Usual Diet Controls . MAIN OUTCOMES MEASURES Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP . STATISTICAL ANALYSES PERFORMED General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet . Linear regression was used to examine potential predictors of post-treatment DASH adherence . Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP . RESULTS Participants in the DASH diet plus weight management ( 16.1 systolic BP [ SBP ] ; 95 % CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [ DBP ] ; 95 % CI 8.1 to 11.6 mm Hg ) and DASH diet alone ( 11.2 SBP ; 95 % CI 8.1 to 14.3 mm Hg and 7.5 DBP ; 95 % CI 5.8 to 9.3 mm Hg ) groups showed significant reductions in BP in comparison with Usual Diet Controls participants ( 3.4 SBP ; 95 % CI 0.4 to 6.4 mm Hg and DBP 3.8 ; 95 % CI 2.2 to 5.5 mm Hg ) . Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone ( mean = 6.20 ; 95 % CI 5.83 to 6.57 ) and DASH diet plus weight management groups ( mean = 6.23 ; 95 % CI 5.88 to 6.59 ) compared with Usual Diet Controls ( mean = 3.66 ; 95 % CI 3.30 to 4.01 ; P<0.0001 ) , and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP ( P ≤ 0.01 ) . Only ethnicity predicted dietary adherence , with African Americans less adherent to the DASH diet compared with whites ( 4.68 ; 95 % CI 4.34 to 5.03 vs 5.83 ; 95 % CI 5.50 to 6.11 ; P<0.001 ) . CONCLUSIONS Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss . African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites , suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet R and omized trials have shown that increasing potassium intake lowers blood pressure . However , most previous trials used potassium chloride , whereas potassium in fruits and vegetables is not a chloride salt . It is unclear whether a nonchloride salt of potassium has a greater or lesser effect on blood pressure compared with potassium chloride . We performed a r and omized crossover trial comparing potassium chloride with potassium citrate ( 96 mmol/d , each for 1 week ) in 14 hypertensive individuals . At baseline , blood pressure was 151±16/93±7 mm Hg with a 24-hour urinary potassium of 81±24 mmol . During the r and omized crossover part of the study , blood pressure was 140±12/88±7 mm Hg with potassium chloride ( 24-hour urinary potassium : 164±36 mmol ) and 138±12/88±6 mm Hg with potassium citrate ( 24-hour urinary potassium : 160±33 mmol ) . These blood pressures were significantly lower compared with that at baseline ; however , there was no significant difference in blood pressure between potassium chloride and potassium citrate , mean difference ( 95 % confidence interval ) : 1.6 ( −2.3 to 5.6 ) mm Hg for systolic and 0.6 ( −2.4 to 3.7 ) mm Hg for diastolic . Our results , in conjunction with the evidence from many previous trials that potassium chloride has a significant blood pressure-lowering effect , suggest that potassium citrate has a similar effect on blood pressure as potassium chloride . These results support other evidence for an increase in potassium intake and indicate that potassium does not need to be given in the form of chloride to lower blood pressure . Increasing the consumption of foods high in potassium is likely to have the same effect on blood pressure as potassium chloride BACKGROUND Weight loss reduces blood pressure , and the Dietary Approaches to Stop Hypertension ( DASH ) diet has also been shown to lower blood pressure . OBJECTIVE Our goal was to assess the effect on blood pressure of 2 weight-reduction diets : a low-fat diet ( LF diet ) and a moderate-sodium , high-potassium , high-calcium , low-fat DASH diet ( WELL diet ) . DESIGN After baseline measurements , 63 men were r and omly assigned to either the WELL or the LF diet for 12 wk , and both diet groups undertook 0.5 h of moderate physical activity on most days of the week . RESULTS Fifty-four men completed the study . Their mean ( + /-SD ) age was 47.9 + /- 9.3 y ( WELL diet , n = 27 ; LF diet , n = 27 ) , and their mean baseline home systolic and diastolic blood pressures were 129.4 + /- 11.3 and 80.6 + /- 8.6 mm Hg , respectively . Body weight decreased by 4.9 + /- 0.6 kg ( + /-SEM ) in the WELL group and by 4.6 + /- 0.6 kg in the LF group ( P < 0.001 for both ) . There was a greater decrease in blood pressure in the WELL group than in the LF group [ between-group difference ( week 12 -baseline ) in both SBP ( 5.5 + /- 1.9 mm Hg ; P = 0.006 ) and DBP ( 4.4 + /- 1.2 mm Hg ; P = 0.001 ) ] . CONCLUSIONS For a comparable 5-kg weight loss , a diet high in low-fat dairy products , vegetables , and fruit ( the WELL diet ) result ed in a greater decrease in blood pressure than did the LF diet . This dietary approach to achieving weight reduction may confer an additional benefit in reducing blood pressure in those who are overweight K-rich fruit and vegetables may lower blood pressure ( BP ) and improve vascular function . A r and omised controlled trial ( IS RCT N50011192 ) with a cross-over design was conducted in free-living participants with early stages of hypertension ( diastolic BP>80 and < 100 mmHg , not receiving BP-lowering medication ) to test this hypothesis . Following a 3-week run-in period on a control diet , each subject completed four dietary 6-week dietary interventions ( control+placebo capsules , an additional 20 or 40 mmol K(+)/d from fruit and vegetables or 40 mmol potassium citrate capsules/d ) using a Latin square design with a washout period ≥ 5 weeks between the treatment periods . Out of fifty-seven subjects who were r and omised , twenty-three male and twenty-five female participants completed the study ; compliance to the intervention was corroborated by food intake records and increased urinary K(+ ) excretion ; plasma lipids , vitamin C , folate and homocysteine concentrations , urinary Na excretion , and body weight remained were unchanged . On the control diet , mean ambulatory 24 h systolic/diastolic BP were 132·3 ( sd 12·0)/81·9 ( ( SD ) 7·9 ) mmHg , and changes ( Bonferroni 's adjusted 95 % CI ) compared with the control on the diets providing 20 and 40 mmol K(+)/d as fruit and vegetables were 0·8 ( - 3·5 , 5·3)/0·8 ( - 1·9 , 3·5 ) and 1·7 ( - 3·0 , 5·3)/1·5 ( - 1·5 , 4·4 ) , respectively , and were 1·8 ( - 2·1 , 5·8)/1·4 ( - 1·6 , 4·4 ) mmHg on the 40 mmol potassium citrate supplement , and were not statistically significant . Arterial stiffness , endothelial function , and urinary and plasma isoprostane and C-reactive protein ( CRP ) concentrations did not differ significantly between the diets . The present study provides no evidence to support dietary advice to increase K intake above usual UK intakes in the subjects with early stages of hypertension Background The incidence of Hypertension as a major cardiovascular threat is increasing . The best known diet for hypertensives is ' no added salt diet'.In this study we evaluated the effect of ' no added salt diet ' on a hypertensive population with high dietary sodium intake by measuring 24 hour urinary sodium excretion . Methods In this single center r and omized study 80 patients ( 60 cases and 20 controls ) not on any drug therapy for hypertension with mild to moderate hypertension were enrolled . 24 hour holter monitoring of BP and 24 hour urinary sodium excretion were measured before and after 6 weeks of ' no added salt diet ' . Results There was no statistically significant difference between age , weight , sex , Hyperlipidemia , family history of hypertension , mean systolic and diastolic BP during the day and at night and mean urinary sodium excretion in 24 hour urine of case and control groups . Seventy eight percent of all patients had moderate to high salt intake . After 6 week of ' no added salt diet ' systolic and diastolic BP significantly decreased during the day ( mean decrease : 12.1/6.8 mmhg ) and at night ( mean decrease : 11.1/5.9 mmhg ) which is statistically significant in comparison to control group ( P 0.001 and 0.01).Urinary sodium excretion of 24 hour urine decreased by 37.1 meq/d ± 39,67 mg/dl in case group which is statistically significant in comparison to control group ( p : 0.001).Only 36 % of the patients , after no added salt diet , reached the pretreatment goal of 24 hour urinary sodium excretion of below 100 meq/dl ( P:0.001 ) . Conclusion Despite modest effect on dietary sodium restriction , no added salt diet significantly decreased systolic and diastolic BP and so it should be advised to every hypertensive patient . Trial Registration Clinical trial.govnumber BACKGROUND Low 25-hydroxy-vitamin D ( 25(OH)D ) levels are inversely related to blood pressure ( BP ) and have been associated with incident hypertension . In people living at northern latitudes diminished cholecalciferol synthesis in the winter increases the risk of vitamin D deficiency . We wanted to test the hypothesis that daily cholecalciferol supplementation in the winter lowers BP in patients with hypertension . METHODS We investigated the effect of 75 µg ( 3,000 IU ) cholecalciferol per day in a r and omized , placebo-controlled , double-blind study in 130 hypertensive patients residing in Denmark ( 56º N ) . Ambulatory BP ( 24-h BP ) and arterial stiffness were measured before and after 20 weeks of treatment , that took place between October and March . RESULTS A total of 112 patients ( mean age 61 ± 10 ) with a baseline p-25(OH)D of 23 ± 10 ng/ml completed the study . Compared with placebo , a nonsignificant 3/1 mm Hg ( P = 0.26/0.18 ) reduction was found in 24-h BP . In patients with vitamin D insufficiency ( < 32 ng/ml ) at baseline ( n = 92 ) , 24-h BP decreased by 4/3 mm Hg ( P = 0.05/0.01 ) . Central BP ( CBP ) estimated by applanation tonometry and calibrated with a st and ardized office BP Output:

To reduce BP in adults with HTN , there is strong evidence to recommend provision of medical nutrition therapy by an RDN , adoption of the Dietary Approaches to Stop Hypertension dietary pattern , calcium supplementation , physical activity as a component of a healthy lifestyle , reduction in dietary sodium intake , and reduction of alcohol consumption in heavy drinkers . Finally , recommendations related to lowering BP were formulated on vitamin D , magnesium , and the putative role of alcohol consumption in moderate drinkers ( weak evidence ) .

MS2_1shot525

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE Computerized medical decision support tools have been shown to improve the quality of care and have been cited by the Institute of Medicine as one method to reduce pharmaceutical errors . We evaluated the impact of an antiinfective decision support tool in a pediatric intensive care unit ( PICU ) . METHODS We enhanced an existing adult antiinfective management tool by adding and changing medical logic to make it appropriate for pediatric patients . Process and outcomes measures were monitored prospect ively during a 6-month control and a 6-month intervention period . M and atory use of the decision support tool was initiated for all antiinfective orders in a 26-bed PICU during the intervention period . Clinician opinions of the decision support tool were surveyed via question naire . RESULTS The rate of pharmacy interventions for erroneous drug doses declined by 59 % . The rate of anti-infective subtherapeutic patient days decreased by 36 % , and the rate of excessive-dose days declined by 28 % . The number of orders placed per antiinfective course decreased 11.5 % , and the robust estimate of the antiinfective costs per patient decreased 9 % . The type of anti-infectives ordered and the number of antiinfective doses per patient remained similar , as did the rates of adverse drug events and antibiotic-bacterial susceptibility mismatches . The surveyed clinicians reported that use of the program improved their antiinfective agent choices as well as their awareness of impairments in renal function and reduced the likelihood of adverse drug events . CONCLUSIONS Use of the pediatric antiinfective decision support tool in a PICU was considered beneficial to patient care by the clinicians and reduced the rates of erroneous drug orders , improved therapeutic dosage targets , and was associated with a decreased robust estimate of antiinfective costs per patient . antiinfective agents , decision support systems , drug therapy , medication errors , child , infant BACKGROUND Adverse drug-related events are common in the elderly , and inappropriate prescribing is a preventable risk factor . Our objective was to determine whether inappropriate prescribing could be reduced when primary care physicians had computer-based access to information on all prescriptions dispensed and automated alerts for potential prescribing problems . METHODS We r and omly assigned 107 primary care physicians with at least 100 patients aged 66 years and older ( total 12 560 ) to a group receiving computerized decision-making support ( CDS ) or a control group . Physicians in the CDS group had access to information on current and past prescriptions through a dedicated computer link to the provincial seniors ' drug-insurance program . When any of 159 clinical ly relevant prescribing problems were identified by the CDS software , the physician received an alert that identified the nature of the problem , possible consequences and alternative therapy . The rate of initiation and discontinuation of potentially inappropriate prescriptions was assessed over a 13-month period . RESULTS In the 2 months before the study , 31.8 % of the patients in the CDS group and 33.3 % of those in the control group had at least 1 potentially inappropriate prescription . During the study the number of new potentially inappropriate prescriptions per 1000 visits was significantly lower ( 18 % ) in the CDS group than in the control group ( relative rate [ RR ] 0.82 , 95 % confidence interval [ CI ] 0.69 - 0.98 ) , but differences between the groups in the rate of discontinuation of potentially inappropriate prescriptions were significant only for therapeutic duplication by the study physician and another physician ( RR 1.66 , 95 % CI 0.99 - 2.79 ) and drug interactions caused by prescriptions written by the study physician ( RR 2.15 , 95 % CI 0.98 - 4.70 ) . INTERPRETATION Computer-based access to complete drug profiles and alerts about potential prescribing problems reduces the rate of initiation of potentially inappropriate prescriptions but has a more selective effect on the discontinuation of such prescriptions BACKGROUND Medication errors are common , and while most such errors have little potential for harm they cause substantial extra work in hospitals . A small proportion do have the potential to cause injury , and some cause preventable adverse drug events . OBJECTIVE To evaluate the impact of computerized physician order entry ( POE ) with decision support in reducing the number of medication errors . DESIGN Prospect i ve time series analysis , with four periods . SETTING AND PARTICIPANTS All patients admitted to three medical units were studied for seven to ten-week periods in four different years . The baseline period was before implementation of POE , and the remaining three were after . Sophistication of POE increased with each successive period . INTERVENTION Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings . MAIN OUTCOME MEASURE Medication errors , excluding missed dose errors . RESULTS During the study , the non-missed-dose medication error rate fell 81 percent , from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period ( P < 0.0001 ) . Non-intercepted serious medication errors ( those with the potential to cause injury ) fell 86 percent from baseline to period 3 , the final period ( P = 0.0003 ) . Large differences were seen for all main types of medication errors : dose errors , frequency errors , route errors , substitution errors , and allergies . For example , in the baseline period there were ten allergy errors , but only two in the following three periods combined ( P < 0.0001 ) . CONCLUSIONS Computerized POE substantially decreased the rate of non-missed-dose medication errors . A major reduction in errors was achieved with the initial version of the system , and further reductions were found with addition of decision support features BACKGROUND Physicians frequently need to start antibiotic therapy before the results of bacterial cultures and antibiotic susceptibility tests are available . We developed and evaluated a computerized antibiotic consultant to assist physicians in the selection of appropriate empiric antibiotics . METHODS We used a two-stage r and om- selection study to compare antibiotics suggested by the antibiotic consultant with 482 associated antibiotic susceptibility results and the concurrent antibiotics ordered by physicians . The antibiotics ordered by r and omized physicians were then compared between crossover periods of antibiotic consultant use . RESULTS The antibiotic consultant suggested an antibiotic regimen to which all isolated pathogens were shown to be susceptible for 453 ( 94 % ) of 482 culture results , while physicians ordered an antibiotic regimen to which all isolated pathogens were susceptible for 369 culture results ( 77 % ) ( P < .001 ) . The physicians who prescribed antibiotics to which all pathogens were susceptible did so a mean of 21 hours after the culture specimens were collected . Physicians ordered appropriate antibiotics within 12 hours of the culture collection significantly more often when they had use of the antibiotic consultant than during the period before use ( P < .035 ) . Moreover , 88 % of the physicians stated they would recommend the program to other physicians , 85 % said the program improved their antibiotic selection , and 81 % said they felt use of the program improved patient care . CONCLUSIONS Information from computer-based medical records can be used to help improve physicians ' selection of empiric antibiotics for infections Introduction Medication errors in the intensive care unit ( ICU ) are frequent and lead to attributable patient morbidity and mortality , increased length of ICU stay and substantial extra costs . We investigated if the introduction of a computerized ICU system ( Centricity Critical Care Clinisoft , GE Healthcare ) reduced the incidence and severity of medication prescription errors ( MPEs ) . Methods A prospect i ve trial was conducted in a paper-based unit ( PB-U ) versus a computerized unit ( C-U ) in a 22-bed ICU of a tertiary university hospital . Every medication order and medication prescription error was vali date d by a clinical pharmacist . The registration of different classes of MPE was done according to the National Coordinating Council for Medication Error Reporting and Prevention guidelines . An independent panel evaluated the severity of MPEs . We identified three groups : minor MPEs ( no potential to cause harm ) ; intercepted MPEs ( potential to cause harm but intercepted on time ) ; and serious MPEs ( non-intercepted potential adverse drug events ( ADE ) or ADEs , being MPEs with potential to cause , or actually causing , patient harm ) . Results The C-U and the PB-U each contained 80 patient-days , and a total of 2,510 medication prescriptions were evaluated . The clinical pharmacist identified 375 MPEs . The incidence of MPEs was significantly lower in the C-U compared with the PB-U ( 44/1286 ( 3.4 % ) versus 331/1224 ( 27.0 % ) ; P < 0.001 ) . There were significantly less minor MPEs in the C-U than in the PB-U ( 9 versus 225 ; P < 0.001 ) . Intercepted MPEs were also lower in the C-U ( 12 versus 46 ; P < 0.001 ) , as well as the non-intercepted potential ADEs ( 21 versus 48 ; P < 0.001 ) . There was also a reduction of ADEs ( 2 in the C-U versus 12 in the PB-U ; P < 0.01 ) . No fatal errors occurred . The most frequent drug classes involved were cardiovascular medication and antibiotics in both groups . Patients with renal failure experienced less dosing errors in the C-U versus the PB-U ( 12 versus 35 serious MPEs ; P < 0.001 ) . Conclusion The ICU computerization , including the medication order entry , result ed in a significant decrease in the occurrence and severity of medication errors in the ICU Introduction The study aim ed to compare the impact of computerised physician order entry ( CPOE ) without decision support with h and -written prescribing ( HWP ) on the frequency , type and outcome of medication errors ( MEs ) in the intensive care unit . Methods Details of MEs were collected before , and at several time points after , the change from HWP to CPOE . The study was conducted in a London teaching hospital 's 22-bedded general ICU . The sampling periods were 28 weeks before and 2 , 10 , 25 and 37 weeks after introduction of CPOE . The unit pharmacist prospect ively recorded details of MEs and the total number of drugs prescribed daily during the data collection periods , during the course of his normal chart review . Results The total proportion of MEs was significantly lower with CPOE ( 117 errors from 2429 prescriptions , 4.8 % ) than with HWP ( 69 errors from 1036 prescriptions , 6.7 % ) ( p < 0.04 ) . The proportion of errors reduced with time following the introduction of CPOE ( p < 0.001 ) . Two errors with CPOE led to patient harm requiring an increase in length of stay and , if administered , three prescriptions with CPOE could potentially have led to permanent harm or death . Differences in the types of error between systems were noted . There was a reduction in major/moderate patient outcomes with CPOE when non-intercepted and intercepted errors were combined ( p = 0.01 ) . The mean baseline APACHE II score did not differ significantly between the HWP and the CPOE periods ( 19.4 versus 20.0 , respectively , p = 0.71 ) . Conclusion Introduction of CPOE was associated with a reduction in the proportion of MEs and an improvement in the overall patient outcome score ( if intercepted errors were included ) . Moderate and major errors , however , remain a significant concern with CPOE CONTEXT Adverse drug events ( ADEs ) are a significant and costly cause of injury during hospitalization . OBJECTIVES To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors , defined as those that either result ed in or had potential to result in an ADE and were not intercepted before reaching the patient . DESIGN Before-after comparison between phase 1 ( baseline ) and phase 2 ( after intervention was implemented ) and , within phase 2 , a r and omized comparison between physician computer order entry ( POE ) and the combination of POE plus a team intervention . SETTING Large tertiary care hospital . PARTICIPANTS For the comparison of phase 1 and 2 , all patients admitted to a stratified r and om sample of 6 medical and surgical units in a tertiary care hospital over a 6-month period , and for the r and omized comparison during phase 2 , all patients admitted to the same units and 2 r and omly selected additional units over a subsequent 9-month period . INTERVENTIONS A physician computer order entry system ( POE ) for all units and a team-based intervention that included changing the role of pharmacists , implemented for half the units . MAIN OUTCOME MEASURE Nonintercepted serious medication errors . RESULTS Comparing identical units between phases 1 and 2 , nonintercepted serious medication errors decreased 55 % , from 10.7 events per 1000 patient-days to 4.86 events per 1000 ( P=.01 ) . The decline occurred for all stages of the medication-use process . Preventable ADEs declined 17 % from 4.69 to 3.88 ( P=.37 ) , while nonintercepted potential ADEs declined 84 % from 5.99 to 0.98 per 1000 patient-days ( P=.002 ) . When POE-only was compared with the POE plus team intervention combined , the team intervention conferred no additional benefit over PO Output:

Concluding , it seems that electronic prescribing can reduce the risk for medication errors and ADE .

MS2_1shot526

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Although there is r and omized evidence that radical prostatectomy improves survival , there are few data on how benefit varies by baseline risk . OBJECTIVE We aim ed to create a statistical model to calculate the decrease in risk of death associated with surgery for an individual patient , using stage , grade , prostate-specific antigen , and age as predictors . DESIGN , SETTING , AND PARTICIPANTS A total of 695 men with T1 or T2 prostate cancer participated in the Sc and inavian Prostate Cancer Group 4 trial ( SPCG-4 ) . INTERVENTION Patients in SPCG-4 were r and omized to radical prostatectomy or conservative management . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing risk models were created separately for the radical prostatectomy and the watchful waiting group , with the difference between model predictions constituting the estimated benefit for an individual patient . RESULTS AND LIMITATIONS Individualized predictions of surgery benefit varied widely depending on age and tumor characteristics . At 65 yr of age , the absolute 10-yr risk reduction in prostate cancer mortality attributable to radical prostatectomy ranged from 4.5 % to 17.2 % for low- versus high-risk patients . Little expected benefit was associated with surgery much beyond age 70 . Only about a quarter of men had an individualized benefit within even 50 % of the mean . A limitation is that estimates from SPCG-4 have to be applied cautiously to contemporary patients . CONCLUSIONS Our model suggests that it is hard to justify surgery in patients with Gleason 6 , T1 disease or in those patients much above 70 yr of age . Conversely , surgery seems unequivocally of benefit for patients who have Gleason 8 , or Gleason 7 , stage T2 . For patients with Gleason 6 T2 and Gleason 7 T1 , treatment is more of a judgment call , depending on patient preference and other clinical findings , such as the number of positive biopsy cores and comorbidities BACKGROUND The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen ( PSA ) testing remains uncertain . METHODS We compared active monitoring , radical prostatectomy , and external-beam radiotherapy for the treatment of clinical ly localized prostate cancer . Between 1999 and 2009 , a total of 82,429 men 50 to 69 years of age received a PSA test ; 2664 received a diagnosis of localized prostate cancer , and 1643 agreed to undergo r and omization to active monitoring ( 545 men ) , surgery ( 553 ) , or radiotherapy ( 545 ) . The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up . Secondary outcomes included the rates of disease progression , metastases , and all-cause deaths . RESULTS There were 17 prostate-cancer-specific deaths overall : 8 in the active-monitoring group ( 1.5 deaths per 1000 person-years ; 95 % confidence interval [ CI ] , 0.7 to 3.0 ) , 5 in the surgery group ( 0.9 per 1000 person-years ; 95 % CI , 0.4 to 2.2 ) , and 4 in the radiotherapy group ( 0.7 per 1000 person-years ; 95 % CI , 0.3 to 2.0 ) ; the difference among the groups was not significant ( P=0.48 for the overall comparison ) . In addition , no significant difference was seen among the groups in the number of deaths from any cause ( 169 deaths overall ; P=0.87 for the comparison among the three groups ) . Metastases developed in more men in the active-monitoring group ( 33 men ; 6.3 events per 1000 person-years ; 95 % CI , 4.5 to 8.8 ) than in the surgery group ( 13 men ; 2.4 per 1000 person-years ; 95 % CI , 1.4 to 4.2 ) or the radiotherapy group ( 16 men ; 3.0 per 1000 person-years ; 95 % CI , 1.9 to 4.9 ) ( P=0.004 for the overall comparison ) . Higher rates of disease progression were seen in the active-monitoring group ( 112 men ; 22.9 events per 1000 person-years ; 95 % CI , 19.0 to 27.5 ) than in the surgery group ( 46 men ; 8.9 events per 1000 person-years ; 95 % CI , 6.7 to 11.9 ) or the radiotherapy group ( 46 men ; 9.0 events per 1000 person-years ; 95 % CI , 6.7 to 12.0 ) ( P<0.001 for the overall comparison ) . CONCLUSIONS At a median of 10 years , prostate-cancer-specific mortality was low irrespective of the treatment assigned , with no significant difference among treatments . Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring . ( Funded by the National Institute for Health Research ; ProtecT Current Controlled Trials number , IS RCT N20141297 ; Clinical Trials.gov number , NCT02044172 . ) Prostate intervention versus observation trial ( PIVOT ) is the largest and longest r and omized trial conducted in men with early stage prostate cancer detected during the era of wide-spread prostate-specific antigen ( PSA ) testing.1 PIVOT enrolled 731 men and followed them for up to 15 years after r and omization . PIVOT results demonstrate that compared to observation , radical prostatectomy did not result in a significant reduction in all cause or prostate cancer mortality through at least 12 years among men with localized prostate cancer ; absolute differences were less than 3 % . Results changed little after 8 years ; therefore , additional follow-up is unlikely to change our findings . Radical prostatectomy caused related harms within 30 days of surgery in 21 % of men and urinary incontinence and erectile dysfunction through at least 2 years . Prostate cancer mortality was infrequent among all men treated with observation ( approximately 8 % ) and rare ( 3 % ) in men with PSA values of 10 or less or those with low-risk disease , which is important and reassuring findings for men , their families and physicians . Noncancer death rates and surgical quality in PIVOT were similar to other studies enrolling men with early stage prostate cancer . The mean age of 67 years , health status and comorbidities were similar to most men diagnosed with prostate cancer and to other trials . The effect of radical prostatectomy did not vary by patient age , race , health status or presence of other medical conditions . In men with low PSA ( ≤10 ) or low-risk disease death from prostate cancer is rare in men treated with observation and surgery had no reduction in overall or prostate cancer mortality or risk of bone metastases . Surgery may reduce mortality and bone metastases in men with higher PSA or higher-risk disease . However , subgroup findings should be viewed with caution . Any positive results were based on multiple subgroups assessed , rarely met traditional levels of statistical significance , often were sensitive to methods of analysis and may be due to chance . Three-quarters of men with early stage prostate cancer have low PSA or low-risk disease . Men diagnosed today and managed with observation likely have even a better prognosis than men enrolled in PIVOT because of detection of smaller more indolent disease . PIVOT results , combined with other data from r and omized treatment and screening trials , indicate that observation should be the preferred treatment strategy for the majority of men currently diagnosed with early stage prostate cancer . Such a strategy can help men live a similar length of life , avoid death from prostate cancer and prevent treatment related harms and costs . In conclusion , PIVOT demonstrated that surgery did not reduce overall or cancer mortality compared to observation through at least 12 years ' absolute differences were less than 3 % . While surgery may reduce mortality in the minority of men with PSA greater than 10 or with high-risk disease , it did not improve outcomes in men with PSA of 10 or less or with low-risk disease . Observation should be recommended as the preferred treatment option ; it results in similar length of life prevention of prostate cancer death and avoids surgical harms . R and omized controlled trials are needed to evaluate new , more effective and safer screening and treatment approaches for men with aggressive prostate cancer Abstract Context To treat or not to treat is one of the most difficult dilemmas facing prostate cancer patients , especially elderly men with early prostate cancer or small cancer that is contained within the prostate . Objective The primary objective of this review is to analyse the treatment options for patients with localised prostate cancer . This information can be considered alongside other important factors like natural history of disease and diagnostic tests . Evidence acquisition Several r and omised and nonr and omised clinical trials published in the literature investigating the natural history of the disease , diagnostic tests , and treatment options for localised prostate cancer have been review ed for this paper . Evidence synthesis Analysis of prostate-specific antigen ( PSA ) kinetics should play a major role in the management of localised prostate cancer . Trials investigating long-term outcomes of active surveillance are under way . Conclusion Taking all these factors into consideration , the data support active surveillance as an appropriate choice for patients with well-differentiated or moderately differentiated , low-volume prostate cancer who have a life expectancy To present the baseline patient‐reported outcome measures ( PROMs ) in the Prostate Testing for Cancer and Treatment ( ProtecT ) r and omized trial comparing active monitoring , radical prostatectomy and external‐beam conformal radiotherapy for localized prostate cancer and to compare results with other population Importance Prostate cancer screening remains controversial because potential mortality or quality -of-life benefits may be outweighed by harms from overdetection and overtreatment . Objective To evaluate the effect of a single prostate-specific antigen ( PSA ) screening intervention and st and ardized diagnostic pathway on prostate cancer – specific mortality . Design , Setting , and Participants The Cluster R and omized Trial of PSA Testing for Prostate Cancer ( CAP ) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practice s across the United Kingdom . R and omization and recruitment of the practice s occurred between 2001 and 2009 ; patient follow-up ended on March 31 , 2016 . Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs st and ard ( unscreened ) practice . Main Outcomes and Measures Primary outcome : prostate cancer – specific mortality at a median follow-up of 10 years . Prespecified secondary outcomes : diagnostic cancer stage and Gleason grade ( range , 2 - 10 ; higher scores indicate a poorer prognosis ) of prostate cancers identified , all-cause mortality , and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic . Results Among 415 357 r and omized men ( mean [ SD ] age , 59.0 [ 5.6 ] years ) , 189 386 in the intervention group and 219 439 in the control group were included in the analysis ( n = 408 825 ; 98 % ) . In the intervention group , 75 707 ( 40 % ) attended the PSA testing clinic and 67 313 ( 36 % ) underwent PSA testing . Of 64 436 with a valid PSA test result , 6857 ( 11 % ) had a PSA level between 3 ng/mL and 19.9 ng/mL , of whom 5850 ( 85 % ) had a prostate biopsy . After a median follow-up of 10 years , 549 ( 0.30 per 1000 person-years ) died of prostate cancer in the intervention group vs 647 ( 0.31 per 1000 person-years ) in the control group ( rate difference , −0.013 per 1000 person-years [ 95 % CI , −0.047 to 0.022 ] ; rate ratio [ RR ] , 0.96 [ 95 % CI , 0.85 to 1.08 ] ; P = .50 ) . The number diagnosed with prostate cancer was higher in the intervention group ( n = 8054 ; 4.3 % ) than in the control group ( n = 7853 ; 3.6 % ) ( RR , 1.19 [ 95 % CI , 1.14 to 1.25 ] ; P < .001 ) . More prostate cancer tumors with a Gleason grade of 6 or lower were identified in the intervention group ( n = 3263/189 386 [ 1.7 % ] ) than in the control group ( n = 2440/219 439 [ 1.1 % ] ) ( difference per 1000 men , 6.11 [ 95 % CI , 5.38 to 6.84 ] ; P < .001 ) . In the analysis of all-cause mortality , there were 25 459 deaths in the intervention group vs 28 306 deaths in the control group ( RR , 0.99 [ 95 % CI , 0.94 to 1.03 ] ; P = .49 ) . In the instrumental variable analysis for prostate cancer mortality , the adherence-adjusted causal RR was 0.93 ( 95 % CI , 0.67 to 1.29 ; P = .66 ) . Conclusions and Relevance Among practice s r and omized to a single PSA screening intervention vs st and ard practice without Output:

Based on long-term follow-up , RP compared with WW probably results in substantially improved oncological outcomes in men with localised prostate cancer but also markedly increases rates of urinary incontinence and erectile dysfunction . Compared to AM , based on follow-up to 10 years , RP probably has similar outcomes with regard to overall and disease-specific survival yet probably reduces the risks of disease progression and metastatic disease . Urinary function and sexual function are probably decreased for the patients treated with RP

MS2_1shot527

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Postoperative surgical site infections are one of the most frequent complications after open abdominal surgery , and triclosan-coated sutures were developed to reduce their occurrence . The aim of the PROUD trial was to obtain reliable data for the effectiveness of triclosan-coated PDS Plus sutures for abdominal wall closure , compared with non-coated PDS II sutures , in the prevention of surgical site infections . METHODS This multicentre , r and omised controlled group-sequential superiority trial was done in 24 German hospitals . Adult patients ( aged ≥18 years ) who underwent elective midline abdominal laparotomy for any reason were eligible for inclusion . Exclusion criteria were impaired mental state , language problems , and participation in another intervention trial that interfered with the intervention or outcome of this trial . A central web-based r and omisation tool was used to r and omly assign eligible participants by permuted block r and omisation with a 1:1 allocation ratio and block size 4 before mass closure to either triclosan-coated sutures ( PDS Plus ) or uncoated sutures ( PDS II ) for abdominal fascia closure . The primary endpoint was the occurrence of superficial or deep surgical site infection according to the Centers for Disease Control and Prevention criteria within 30 days after the operation . Patients , surgeons , and the outcome assessors were masked to group assignment . Interim and final analyses were by modified intention to treat . This trial is registered with the German Clinical Trials Register , number DRKS00000390 . FINDINGS Between April 7 , 2010 , and Oct 19 , 2012 , 1224 patients were r and omly assigned to intervention groups ( 607 to PDS Plus , and 617 to PDS II ) , of whom 1185 ( 587 PDS Plus and 598 PDS II ) were analysed by intention to treat . The study groups were well balanced in terms of patient and procedure characteristics . The occurrence of surgical site infections did not differ between the PDS Plus group ( 87 [ 14·8 % ] of 587 ) and the PDS II group ( 96 [ 16·1 % ] of 598 ; OR 0·91 , 95 % CI 0·66 - 1·25 ; p=0·64 ) . Serious adverse events also did not differ between the groups-146 of 583 ( 25·0 % ) patients treated with PDS Plus had at least one serious adverse event , compared with 138 of 602 ( 22·9 % ) patients treated with PDS II ; p=0·39 ) . INTERPRETATION Triclosan-coated PDS Plus did not reduce the occurrence of surgical site infection after elective midline laparotomy . Innovative , multifactorial strategies need to be developed and assessed in future trials to reduce surgical site infections . FUNDING Johnson & Johnson Medical Limited OBJECTIVES The incidence of surgical site infection ( SSI ) after open vein harvesting in coronary artery bypass grafting ( CABG ) patients ranges in different studies between 2 and 20 % . Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis . We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting . METHODS An investigator-initiated prospect i ve r and omized double-blind single-centre study was performed with 374 patients , r and omized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures ( Vicryl Plus ® and Monocryl Plus ® , Ethicon , Somerville , NJ , USA ) ( n = 184 ) or identical sutures without triclosan ( n = 190 ) from the same manufacturer . All patients were followed up after 30 days ( clinical visit ) and 60 days ( telephone interview ) . Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control . Predefined secondary endpoints included culture-proven and antibiotic-treated SSI . RESULTS The primary endpoint occurred in 23 patients ( 12.5 % ) with triclosan-coated sutures and in 38 patients ( 20.0 % ) in the group without triclosan ( P = 0.0497 , risk ratio 0.63 , ( 95 % confidence interval 0.39–1.00 ) . Corresponding figures for culture-proven infections were 7.6 vs 12.1 % , ( P = 0.15 ) , and for antibiotic-treated infections , 10.9 vs 18.4 % , ( P = 0.039 ) . Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups . Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting . CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting . ( Clinical Trials.gov number NCT01212315 ) OBJECT Implantation of cerebrospinal fluid ( CSF ) shunting devices is associated with a 5 - 15 % risk of infection as cited in contemporary pediatric neurosurgical literature . Shunt infections typically require complete removal of the device and prolonged antibiotic treatment followed by shunt replacement . Moreover , shunt infections are commonly associated with prolonged hospital stays , potential comorbidity , and the increased risk of neurological compromise due to ventriculitis or surgical complications . The authors prospect ively evaluated the incidence of CSF shunt infection following shunt procedures performed using either antimicrobial suture ( AMS ) or conventional suture . METHODS In a single-center , prospect i ve , double-blinded , r and omized controlled trial , the authors enrolled 61 patients , among whom 84 CSF shunt procedures were performed over 21 months . R and omization to the study ( AMS ) or control ( placebo ) group was stratified to minimize the effect of known shunt infection risk factors on the findings . Antibacterial shunt components were not used . The primary outcome measure was the incidence of shunt infection within 6 months of surgery . RESULTS The shunt infection rate in the study group was 2 ( 4.3 % ) of 46 procedures and 8 ( 21 % ) of 38 procedures in the control group ( p = 0.038 ) . There were no statistically significant differences in shunt infection risk factors between the groups ( procedure type and time , age < 6 months , weight < 4 kg , recent history of shunt infection ) . No suture-related adverse events were reported in either group . CONCLUSIONS These results support the suggestion that the use of AMS for CSF shunt surgery wound closure is safe , effective , and may be associated with a reduced risk of postoperative shunt infection . A larger r and omized controlled trial is needed to confirm this association BACKGROUND Surgical site infection ( SSI ) is the fourth commonest healthcare-associated infection and complicates at least 5 % of open operations . In a r and omized clinical trial , antimicrobial-coated sutures were compared with their conventional counterparts , polyglactin and poliglecaprone , for skin closure after breast cancer surgery to assess their role in reducing the rate of SSI . METHODS Between November 2008 and February 2011 , 150 female patients presenting with breast cancer to a single center were r and omized to skin closure with antimicrobial-coated or plain sutures . Postoperatively , SSI was defined using the U.S. Centers for Disease Control and Prevention ( CDC ) definitions and scored using the ASEPSIS or Southampton systems by trained , blinded observers with close post-discharge surveillance and patient diaries . Surgeons and patients were blinded to the type of suture used . RESULTS Using CDC criteria , the overall rate of SSI was 18.9 % at six weeks . Six patients ( 4.7 % ) needed intervention or readmission for SSI . Skin closure with antimicrobial sutures showed a non-statistically significant reduction in the SSI rate , to 15.2 % , compared with conventional sutures ( 22.9 % ) . A uniform tendency for fewer SSIs in the antimicrobial-coated suture group was found using ASEPSIS and Southampton scores , but again , the difference was not statistically significant . CONCLUSION The previously reported high rate of SSI related to breast surgery was confirmed . Using statistical modeling and earlier reports , the study was powered to show a difference using ASEPSIS scores , but the modification used in this trial failed to find a difference . Finding a statistically significant difference would have needed two to three times the number of patients recruited . Further evaluation of antimicrobial-coated sutures is merited , particularly if used as part of a care bundle to reduce SSI after breast cancer surgery BACKGROUND The primary objective of this multicenter post-market study was to compare the cosmetic outcome of triclosan-coated VICRYL Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy . A secondary objective was to assess the incidence of surgical site infection ( SSI ) . METHODS Patients undergoing modified radical mastectomy were r and omly assigned to coated VICRYL Plus antibacterial ( Polyglactin 910 ) suture or Chinese silk suture . Cosmetic outcomes were evaluated postoperatively at days 12 ( ± 2 ) and 30 ( ± 5 ) , and the evidence of SSI was assessed at days 3 , 5 , 7 , 12 ( ± 2 ) , 30 ( ± 5 ) , and 90 ( ± 7 ) . Cosmetic outcomes were independently assessed via visual analogue scale ( VAS ) score evaluations of blinded incision photographs ( primary endpoint ) and surgeon-assessed modified Holl and er Scale ( mHCS ) scores ( secondary endpoint ) . SSI assessment s used both CDC criteria and ASEPSIS scores . RESULTS Six Chinese hospitals r and omized 101 women undergoing modified radical mastectomy to closure with coated VICRYL Plus suture ( n = 51 ) or Chinese silk suture ( n = 50 ) . Mean VAS cosmetic outcome scores for antibacterial suture ( 67.2 ) were better than for Chinese silk ( 45.4 ) at day 30 ( P < 0.0001 ) ) . Mean mHCS cosmetic outcome total scores , were also higher for antibacterial suture ( 5.7 ) than for Chinese silk ( 5.0 ) at day 30 ( P = 0.002 ) . CONCLUSIONS Patients using coated VICRYL Plus suture had significantly better cosmetic outcomes than those with Chinese silk sutures . Patients using coated VICRYL Plus suture had a lower SSI incidence compared to the Chinese silk sutures , although the difference did not reach statistical significance OBJECTIVE To evaluate the efficacy and safety of new antibacterial suture ( Vicryl Plus ) compared with a traditional braided suture ( Vicryl ) in a clinical study . The primary goal was to study effectiveness on reduced surgical site infection in an appendectomy operation . The authors ' secondary goal was to analyze the safety and physical properties of Vicryl plus . MATERIAL AND METHOD This was a prospect i ve , r and omized , controlled , double blind , comparative , single-center study . After appendectomy was done , the patients were r and omized in two groups : Vicryl Plus and Vicryl to selected suture for suturing the abdominal sheath . The surgical site infection was evaluated for 30 days , 6 months , and 1 year . The surgeons and attending doctor were blind to the type of suture . This is the primary report of the first 100 patients . RESULTS There was no difference in demographic and preoperative clinical in both groups . Although there was no statistical difference in the surgical site infection of Vicryl and Vicryl Plus ( 8 and 10 % , p = 0.05 ) , one case of deep surgical site infection was detected in the Vicryl group . No complications and no difference in related suture material s were detected . CONCLUSION Coated polyglactin 910 with tricosan ( Vicryl Plus ) is safe and satisfactory in surgical practice . Surgical site infection of appendectomy seemed too to be comparable between coated polyglactin 910 with tricosan ( Vicryl Plus ) and traditional polyglactin 910 ( Vicryl ) group BACKGROUND Surgical wound infection is a common complication , which increases the hospital stay and costs after surgery for head and neck cancer . In this study , we evaluated the effect of Triclosan-coated sutures on surgical wounds and analyzed the risk factors for wound infections in head and neck cancer surgery . PATIENTS AND METHODS From January 2007 to December 2009 , 253 consecutive patients underwent wide excision of a head or neck cancer and reconstructive procedures . All patient data were collected prospect ively . Of these , 241 patients were included in this study , divided into two groups . The Triclosan group contained 112 patients , whose surgical wounds were closed with Triclosan-coated sutures ( Vicryl Plus ) . The control group included the remaining 129 patients , whose surgical wounds were closed with conventional Vicryl sutures . We conducted a retrospective , multivariate analysis to determine independent risk factors for the cervical wound infection . RESULTS The cervical wound infection rate was 14.9 % ( Output:

CONCLUSION The r and om-effects meta- analysis based on RCTs suggests that TCSs reduced the risk of SSI by 26 % among patients undergoing surgery . This effect was particularly evident among those who underwent abdominal surgery

MS2_1shot528

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background —Endothelial function is impaired in coronary artery disease and may contribute to its clinical manifestations . Increased oxidative stress has been linked to impaired endothelial function in atherosclerosis and may play a role in the pathogenesis of cardiovascular events . This study was design ed to determine whether endothelial dysfunction and vascular oxidative stress have prognostic impact on cardiovascular event rates in patients with coronary artery disease . Methods and Results —Endothelium-dependent and -independent vasodilation was determined in 281 patients with documented coronary artery disease by measuring forearm blood flow responses to acetylcholine and sodium nitroprusside using venous occlusion plethysmography . The effect of the coadministration of vitamin C ( 24 mg/min ) was assessed in a subgroup of 179 patients . Cardiovascular events , including death from cardiovascular causes , myocardial infa rct ion , ischemic stroke , coronary angioplasty , and coronary or peripheral bypass operation , were studied during a mean follow-up period of 4.5 years . Patients experiencing cardiovascular events ( n=91 ) had lower vasodilator responses to acetylcholine ( P < 0.001 ) and sodium nitroprusside ( P < 0.05 ) , but greater benefit from vitamin C ( P < 0.01 ) . The Cox proportional regression analysis for conventional risk factors demonstrated that blunted acetylcholine-induced vasodilation ( P = 0.001 ) , the effect of vitamin C ( P = 0.001 ) , and age ( P = 0.016 ) remained independent predictors of cardiovascular events . Conclusions —Endothelial dysfunction and increased vascular oxidative stress predict the risk of cardiovascular events in patients with coronary artery disease . These data support the concept that oxidative stress may contribute not only to endothelial dysfunction but also to coronary artery disease activity OBJECTIVES The aim of this study was to examine the association between brachial artery flow-mediated dilation ( FMD ) and cardiovascular events in a cohort of initially asymptomatic post-menopausal women , with adjustment for the presence of the major cardiovascular risk factors . BACKGROUND Conventional major cardiovascular risk factors ( cigarette smoking , hypercholesterolemia , hypertension , and diabetes ) fail to explain nearly 50 % of cardiovascular events . Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention . Evaluation of endothelial function , utilizing the noninvasive measurement of the brachial artery FMD , may serve as a screening tool to individualize high-risk patients . METHODS We conducted a prospect i ve study on 2,264 post-menopausal women , age 54 + /- 6 years . The length of the follow-up was 45 + /- 13 months ( range 6 to 65 months ) . RESULTS During observation , 90 major events were recorded . Risk-adjusted relative risk values result ed 1.0 , 1.33 ( 95 % confidence interval [ CI ] 1.09 to 4.09 ) , and 4.42 ( 95 % CI 2.97 to 8.01 ) for women in the higher , intermediate , and lower tertile of FMD , respectively ( p < 0.0001 for trend ) . The event rate for women in the lower tertile ( FMD < or=4.5 % ) was greater than the combined event rate noted in the other 2 tertiles ( women in the lower tertile accounted for 51 events [ 56.6 % of total events ] ) . When added to age and other conventional cardiovascular risk factors ( smoking habits , presence of hypercholesterolemia , history of diabetes , hypertension ) , FMD contributed significantly to the model predicting cardiovascular events ( likelihood ratio chi-square change : 10.22 ; p < 0.0001 ) . CONCLUSIONS In post-menopausal women , the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events Abstract — Flow-mediated dilatation ( FMD ) of conduit arteries is dependent on an intact endothelium , although the mechanisms are not fully understood . Using high-resolution ultrasound , we examined the role of endothelial mediators in radial artery dilatation in response to transient ( short period of reactive hyperemia ) and sustained ( prolonged period of reactive hyperemia , h and warming , or an incremental infusion of acetylcholine into the distal radial artery ) hyperemia . After short episodes of reactive hyperemia , FMD was abolished by local infusion of the nitric oxide synthesis inhibitor NGmonomethyl-l-arginine ( 5.3±1.2 % versus 0.7±0.7 % , P < 0.001 ) . In contrast , basal vessel diameter and dilatation after prolonged episodes of reactive hyperemia , h and warming , and distal infusion of acetylcholine were not attenuated by nitric oxide synthesis inhibition . Inhibition of cyclooxygenase or local autonomic nervous system blockade also had no effect on FMD . Patients with hypercholesterolemia exhibited reduced FMD in response to transient hyperemia , but the response to sustained hyperemia was normal . These data suggest heterogeneity of endothelial responses to blood flow that are dependent on the characteristics of the flow stimulus . Dilatation after brief episodes of hyperemia is mediated by release of nitric oxide , whereas dilatation during sustained hyperemia is unaffected by NO synthesis inhibition . Hypercholesterolemia seems to differentially affect these pathways with impairment of the nitric oxide – dependent pathway and preservation of non nitric oxide – mediated dilatation to sustained flow stimuli Studies of experimental diabetes mellitus ( DM ) suggest that increased nitric oxide ( NO ) bioactivity contributes to renal hyperfiltration . However , the role of NO in mediating hyperfiltration has not been fully eluci date d in humans . Our aim was to examine the effect of NO synthase inhibition on renal and peripheral vascular function in normotensive subjects with uncomplicated type 1 DM . Renal function and brachial artery flow-mediated vasodilatation ( FMD ) were measured before and after an intravenous infusion of the NO synthase inhibitor N(G)-nitro-l-arginine methyl ester ( l-NMMA ) in 21 healthy control and 37 type 1 DM patients . Measurements in DM participants were made under clamped euglycemic conditions . The effect of l-NMMA on circulating and urinary NO metabolites ( NO(x ) ) and cGMP and on urinary prostanoids was also determined . Baseline characteristics were similar in the two groups . For analysis , the DM patients were divided into those with hyperfiltration ( DM-H , n = 18 ) and normal glomerular filtration rate ( GFR ) levels ( DM-N , n = 19 ) . Baseline urine NO(x ) and cGMP were highest in DM-H. l-NMMA led to a decline in GFR in DM-H ( 152 ± 16 to 140 ± 11 ml·min(-1)·1.73 m(-2 ) ) but not DM-N or healthy control participants . The decline in effective renal plasma flow in response to l-NMMA ( 806 ± 112 to 539 ± 80 ml·min(-1)·1.73 m(-2 ) ) in DM-H was also exaggerated compared with the other groups ( repeated measures ANOVA , P < 0.05 ) , along with declines in urinary NO(x ) metabolites and cGMP . Baseline FMD was lowest in DM-H compared with the other groups and did not change in response to l-NMMA . l-NMMA reduced FMD and plasma markers of NO bioactivity in the healthy control and DM-N groups . In patients with uncomplicated type 1 DM , renal hyperfiltration is associated with increased NO bioactivity in the kidney and reduced NO bioactivity in the systemic circulation , suggesting a paradoxical state of high renal and low systemic vascular NO bioactivity Background — We sought to clarify , using functional and biological approaches , the role of epoxyeicosatrienoic acids , nitric oxide (NO)/reactive oxygen species balance , and endothelin-1 in conduit artery endothelial dysfunction during essential hypertension . Methods and Results — Radial artery diameter and mean wall shear stress were determined in 28 untreated patients with essential hypertension and 30 normotensive control subjects during endothelium-dependent flow-mediated dilatation induced by h and skin heating . The role of epoxyeicosatrienoic acids and NO was assessed with the brachial infusion of inhibitors of cytochrome P450 epoxygenases ( fluconazole ) and NO synthase ( NG-monomethyl-L-arginine [ L-NMMA ] ) . Compared with controls , hypertensive patients exhibited a decreased flow-mediated dilatation in response to postischemic hyperemia as well as to heating , as shown by the lesser slope of their diameter – shear stress relationship . In controls , heating-induced flow-mediated dilatation was reduced by fluconazole , L-NMMA , and , to a larger extent , by L-NMMA+fluconazole . In patients , flow-mediated dilatation was not affected by fluconazole and was reduced by L-NMMA and L-NMMA+fluconazole to a lesser extent than in controls . Furthermore , local plasma epoxyeicosatrienoic acids increased during heating in controls ( an effect diminished by fluconazole ) but not in patients . Plasma nitrite , an indicator of NO availability , increased during heating in controls ( an effect abolished by L-NMMA ) and , to a lesser extent , in patients , whereas , inversely , reactive oxygen species increased more in patients ( an effect diminished by L-NMMA ) . Plasma endothelin-1 decreased during heating in controls but not in patients . Conclusions — These results show that an impaired role of epoxyeicosatrienoic acids contributes , together with an alteration in NO/reactive oxygen species balance and endothelin-1 pathway , to conduit artery endothelial dysfunction in essential hypertension . Clinical Trial Registration — https://www.eudract.ema.europa.eu . Unique identifier : RCB2007-A001–10 - 53 BACKGROUND Endothelial vasodilator dysfunction is a characteristic feature of patients at risk for coronary atherosclerosis . Therefore , we prospect ively investigated whether coronary endothelial dysfunction predicts disease progression and cardiovascular event rates . METHODS AND RESULTS Coronary vasoreactivity was assessed in 147 patients using the endothelium-dependent dilator acetylcholine , sympathetic activation by cold pressor testing , dilator responses to increased blood flow , and dilation in response to nitroglycerin . Cardiovascular events ( cardiovascular death , unstable angina , myocardial infa rct ion , percutaneous transluminal coronary angioplasty , coronary bypass grafting , ischemic stroke , or peripheral artery revascularization ) served as outcome variables over a median follow-up period of 7.7 years . Patients suffering from cardiovascular events during follow-up ( n=16 ) had significantly increased vasoconstrictor responses to acetylcholine infusion ( P=0 . 009 ) and cold pressor testing ( P=0.002 ) , as well as significantly blunted vasodilator responses to increased blood flow ( P<0.001 ) and the intracoronary injection of nitroglycerin ( P=0.001 ) . Impaired endothelial and endothelium-independent coronary vasoreactivity were associated with a significantly higher incidence of cardiovascular events by Kaplan-Meier analysis . By multivariate analysis , all tests of coronary vasoreactivity were significant , independent predictors of a poor prognosis , even after adjustment for traditional cardiovascular risk factors or the presence of atherosclerosis itself . CONCLUSIONS Coronary endothelial vasodilator dysfunction predicts long-term atherosclerotic disease progression and cardiovascular event rates . Thus , the assessment of coronary endothelial vasoreactivity can provide pivotal information as both a diagnostic and prognostic tool in patients at risk for coronary heart disease Design and participants A double-blind , crossover , r and omized study was design ed to evaluate the effect of 3-month treatment with a lower versus a higher antihypertensive dosage of ramipril ( 5 or 10 mg/day ) on nitric oxide (NO)-dependent vasodilation in 46 untreated patients with essential hypertension . Radial artery flow-mediated dilation ( FMD ) , before and after the intra-arterial infusion of NG-monomethyl-L-arginine ( L-NMMA ) , to block NO synthase , and the response to sublingual glyceril trinitrate ( GTN , 25 μg ) were measured at baseline and after the two treatment periods as a change in artery diameter ( computerized system from ultrasound scans ) . Plasma angiotensin II and oxidative stress markers were also assessed . Results FMD was significantly ( P < 0.01 ) lower in hypertensive patients ( 4.6 ± 1.8 % ) than in normotensive subjects ( 7.1 ± 2.6 % ) , whereas the response to GTN was similar . L-NMMA significantly ( P < 0.001 ) inhibited FMD in normotensive but not in hypertensive Output:

This comprehensive analysis demonstrates that FMD of conduit arteries in humans is , at least in part , mediated by NO

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background A variety of minimally invasive parathyroidectomy ( MIP ) techniques have been currently introduced to surgical management of primary hyperparathyroidism ( pHPT ) caused by a solitary parathyroid adenoma . This study aim ed at comparing the video-assisted MIP ( MIVAP ) and open MIP ( OMIP ) in a prospect i ve , r and omized , blinded trial . Material s and Methods Among 84 consecutive pHPT patients referred for surgery , 60 individuals with concordant localization of parathyroid adenoma on ultrasound and subtraction Tc99m-MIBI scintigraphy were found eligible for MIP under general anesthesia and were r and omized to two groups ( n = 30 each ) : MIVAP and OMIP . An intraoperative intact parathyroid hormone ( iPTH ) assay was routinely used in both groups to determine the cure . Primary end-points were the success rate in achieving the cure from hyperparathyroid state and hypocalcemia rate . Secondary end-points were operating time , scar length , pain intensity assessed by the visual-analogue scale , analgesia request rate , analgesic consumption , quality of life within 7 postoperative days ( SF-36 ) , cosmetic satisfaction , duration of postoperative hospitalization , and cost-effectiveness analysis . Results All patients were cured . In 2 patients , an intraoperative iPTH assay revealed a need for further exploration : in one MIVAP patient , subtotal parathyroidectomy for parathyroid hyperplasia was performed with the video-assisted approach , and in an OMIP patient , the approach was converted to unilateral neck exploration with the final diagnosis of double adenoma . MIVAP versus OMIP patients were characterized by similar operative time ( 44.2 ± 18.9 vs. 49.7 ± 15.9 minutes ; P = 0.22 ) , transient hypocalcemia rate ( 3 vs. 3 individuals ; P = 1.0 ) , lower pain intensity at 4 , 8 , 12 , and 24 hours after surgery ( 24.9 ± 6.1 vs. 32.2 ± 4.6 ; 26.4 ± 4.5 vs. 32.0 ± 4.0 ; 19.6 ± 4.9 vs. 25.4 ± 3.8 ; 15.5 ± 5.5 vs. 20.4 ± 4.7 points , respectively ; P < 0.001 ) , lower analgesia request rate ( 63.3 % vs. 90 % ; P = 0.01 ) , lower analgesic consumption ( 51.6 ± 46.4 mg vs. 121.6 ± 50.3 mg of ketoprofen ; P < 0.001 ) , better physical functioning aspect and bodily pain aspect of the quality of life on early recovery ( 88.4 ± 6.9 vs. 84.6 ± 4.7 and 90.3 ± 4.7 vs. 87.5 ± 5.8 ; P = 0.02 and P = 0.003 , respectively ) , shorter scar length ( 17.2 ± 2.2 mm vs. 30.8 ± 4.0 mm ; P < 0.001 ) , and higher cosmetic satisfaction rate at 1 month after surgery ( 85.4 ± 12.4 % vs. 77.4 ± 9.7 % ; P = 0.006 ) . Cosmetic satisfaction was increasing with time , and there were no significant differences at 6 months postoperatively . MIVAP was more expensive ( US$ 1,150 ± 63.4 vs. 1,015 ± 61.8 ; P < 0.001 ) while the mean hospital stay was similar ( 28 ± 10.1 vs. 31.1 ± 9.7 hours ; P = 0.22 ) . Differences in serum calcium values and iPTH during 6 months of follow-up were nonsignificant . Transient laryngeal nerve palsy appeared in one OMIP patient ( P = 0.31 ) . There was no other morbidity or mortality . Conclusions Both MIVAP and OMIP offer a valuable approach for solitary parathyroid adenoma with a similar excellent success rate and a minimal morbidity rate . Routine use of the intraoperative iPTH assay is essential in both approaches to avoid surgical failures of overlooked multigl and ular disease . The advantages of MIVAP include easier recognition of recurrent laryngeal nerve ( RLN ) , lower pain intensity within 24 hours following surgery , lower analgesia request rate , lower analgesic consumption , shorter scar length , better physical functioning and bodily pain aspects of the quality of life on early recovery , and higher early cosmetic satisfaction rate . However , these advantages are achieved at higher costs because of endoscopic tool involvement BACKGROUND AND PURPOSE Robotic surgery allows three-dimensional ( 3D ) viewing of tissues . We compared two-dimensional ( 2D ) and 3D suturing drills using the daVinci surgical system to determine if the latter is advantageous . MATERIAL S AND METHODS Twenty-eight anastomotic drills were completed by seven surgeons using the daVinci robot . Three surgeons had considerable ( > 6 months ) robotic experience , and four had none . Drills were performed r and omly in both dimensional modes in a blinded fashion . Drill 1 was an interrupted four stitch and drill 2 a running closure . All tasks were kept uniform . We recorded time to completion , difficulty , and accuracy . The drills were evaluated by two independent review ers for accuracy and major errors ( i.e. , broken suture , torn graft ) . RESULTS The average operative time per drill in two dimensions was 13.1 minutes ( range 6.9 - 21.9 minutes ) and in three dimensions was 8.5 minutes ( range 4.7 - 12.8 minutes ) ( P<0.001 ) . Drill 1 was 6.1 minutes faster in three dimensions ( mean 9.2 minutes ; P<0.01 ) , and drill 2 was 2.9 minutes faster ( mean 7.8 minutes ; P=0.03 ) . Both advanced and novice groups were faster in 3D ( P<0.01 ) . There were two major errors in the 3D performances and 5 in the 2D exercises ( P<0.05 ) . The participants correctly identified the dimensional mode 92.9 % of the time ( P<0.01 ) . CONCLUSION The anastomosis was completed 65 % faster using 3D with equal , if not greater , accuracy . Drill 1 was improved to a greater degree than drill 2 , suggesting most benefit of 3D views during knot tying . Use of three dimensions outperformed two dimensions in both groups . Surgeons can immediately benefit from 3D viewing during robotic surgery Background and aims Laparoscopic surgery has become the treatment of choice for cholecystectomy . Many studies showed that while this approach benefits the patient , the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence . Robots have the potential to overcome these problems . To evaluate the efficiency and feasibility of robotically assisted surgery ( RAC ) , we design ed a prospect i ve study to compare it with st and ard laparoscopic cholecystectomy ( SLC ) . Material s and methods Between 2001 and 2003 , 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system . The feasibility , safety , and possible advantages were evaluated . To assess the efficacy , the total time in the operating room was divided into preoperative , operative , and postoperative time frames . Results For RAC in comparison with SLC , the preoperative phase including equipment setup was significantly longer . In the intraoperative phase , the cut-closure time and camera and trocar insertion times were significantly longer . It is interesting to note that the net dissection time for the cystic artery , duct , and the gall bladder was not different from SLC . Conclusions The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity . There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore , presents no benefit in using the robot in laparoscopic cholecystectomy Robotic laparoscopic surgery is postulated to result in better surgical results by allowing improved instrument manipulation and three-dimensional vision . The authors ’ experience performing robot-assisted laparoscopic colorectal surgery is reported . METHOD : St and ard laparoscopic procedures with robot-assisted laparoscopic colon mobilization and vascular ligation were performed . Data relating to the operative procedure , hospital stay , and direct costs were collected . Results were compared with age , gender , and procedure case-matched controls taken from a prospect i ve laparoscopic colorectal surgery data base . RESULTS : Six robot-assisted laparoscopic surgeries ( 2 right hemicolectomies , 3 sigmoid colectomies , and 1 Wells rectopexy ) were performed between December 2001 and June 2002 . There was no associated morbidity . Operative time was increased from a median time of 108 minutes for st and ard laparoscopic colorectal surgery to 165 minutes for robot-assisted laparoscopic surgeries ( P = 0.0313 ; Wilcoxon matched-pairs signed-rank test for non-parametric data ) . This was primarily a result of the time required for robot set-up . Blood loss , length of stay , and hospital cost were not significantly different between groups . Additional direct equipment costs for RAC cases included robotic laparoscopic instruments and sterile drapes ( approximately US $ 350 per case ) , without including acquisition and maintenance costs for the robot . CONCLUSION : Robot-assisted laparoscopic colectomy is a feasible and safe procedure . Although three-dimensional vision and dexterity are facilitated , operative time is increased and the overall additional expense of robotics is of concern . Robot-assisted laparoscopic colectomy requires further evaluation to establish clinical and financial benefits before introduction to routine practice . Such techniques may , in the future , facilitate complex laparoscopic techniques Background This study aim ed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills . Methods Two r and omized groups of students underwent a controlled training program . Both groups completed an identical test before and after training . The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect . To evaluate the subjective feeling of underst and ing and mastering , the students indicated this on a visual analog scale . Results Both groups showed a significant increase in the number of stitches placed during the posttest , and an increase in subjective feeling of underst and ing and mastering . The increase did not differ between the groups , indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique . Conclusions Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator Objective : This study aim ed to compare the outcomes of laparoscopic resection ( LR ) with open resection ( OR ) for right-sided colon cancer . Methods : During the study period from June 2000 to December 2004 , 182 patients ( 84 men ) underwent elective resection for cancer of the right colon . Laparoscopic resection was performed in 77 patients , while 105 patients had open operations . Patients who underwent operations on an emergency basis were excluded . Data on the patients ' demographics , operative details , and postoperative complications were collected prospect ively . The outcomes of patients with laparoscopic resection were compared with those of patients with open surgery . Results : There was no difference in the age , sex , presence of premorbid medical conditions , and blood loss between the 2 groups . The mean operative time for open resection was 115.4 minutes and that for laparoscopic resection was 165.1 minutes ( P<0.001 ) . Among the 77 patients who underwent laparoscopic resection , 7 ( 9 % ) required conversion to an open operation . There was no difference in postoperative surgically related complications including wound infection , leakage , intestinal obstruction , postoperative ileus . Nonsurgical-related complications were also similar . The median time to resumption of a normal diet was 3 days and 4 days in the laparoscopic and open groups , respectively . The median hospital stay in patients with laparoscopic resection was significantly shorter than in patients with open surgery ( 6.0 days vs 7.0 days , P<0.001 ) . The 2-year overall survival rates were 74 % in both groups ( P=0.904 ) . In the converted to open ( LCOR ) group , the hospital stay was significantly longer ( LR vs OR vs LCOR , 5.5 days vs 7.0 days vs 9.0 days respectively , P<0.001 ) . Conclusion : Laparoscopic right hemicolectomy is a safe option for cancers of the right colon . It is associated with a shorter hospital stay and earlier resumption of a normal diet . Mortality and morbidity are similar to that with the open approach . There is no compromise in the survival of patients This study examined the impact of virtual reality ( VR ) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy BACKGROUND It is not clear if robotically assisted surgery ( providing articulating instruments , 3-dimensional vision , intuitive ergonomics ) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients . In the laboratory setting , robots require less time to perform certain tasks . Accordingly , we tested the hypothesis that the time required to perform a robot Output:

Conclusions In the current literature , no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery . Benefits are least disputed when related to surgery using robotics , because there is no haptic feedback in currently used robotics . The addition of haptics is believed to reduce surgical errors result ing from a lack of it , especially in knot tying . Concerning VR training , results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition

MS2_1shot530

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Although telephone and mail are often used to promote physical activity adoption , their ability to produce long-term maintenance is unclear . In this study , 140 men and women aged 50 - 65 years received 1 year of telephone counseling to adopt higher ( i.e. , more vigorous ) versus lower intensity ( i.e. , moderate ) exercise . After 1 year , participants were rer and omized to a 2nd year of contact via ( a ) telephone and mail or ( b ) predominantly mail . Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail . Both strategies were similarly effective in promoting maintenance in the lower intensity condition . Results suggest that after successful adoption of physical activity with the help of telephone counseling , less intensive interventions are successful for physical activity maintenance in older adults Two studies were undertaken to compare strategies for the adoption and maintenance of moderate-intensity , home-based exercise training . In the study of adoption , 52 men and women who had served for 6 months as controls for a study of moderate-intensity , home-based exercise training received 30 minutes of baseline instruction . They were then r and omized to receive continuing instruction and support through 10 staff-initiated telephone contacts of 5 minutes each every 2 weeks , or to receive no telephone contacts . In subjects receiving telephone contacts , peak oxygen uptake increased significantly after 6 months , whereas no increase was observed in subjects receiving no staff support ( p less than 0.05 ) . In the maintenance study , 51 men and women who had significantly increased their peak oxygen uptake by 6 months of moderate-intensity , home-based exercise training were r and omized to undergo daily self-monitoring and receive adherence instructions , or undergo weekly self-monitoring only , during a second 6-month period of training . Subjects performing daily self-monitoring reported completing significantly more exercise training sessions during the 6 months of training than subjects performing weekly self-monitoring ; functional capacity in both groups remained higher than before training ( p less than 0.05 ) . Taken together , these studies suggest that brief baseline instruction followed by continuing telephone contact with staff can be used to help people adopt a moderate-intensity , home-based exercise training program that can be maintained by simple self-monitoring strategies The purpose of this study was to determine how an exercise adherence intervention affects the physiological , functional , and quality of life outcomes of patients with heart failure ( HF ) . Sixteen HF patients were r and omly assigned to an exercise-only group ( n = 8) or to an exercise-with-adherence group ( n = 8) . Two of the 16 people died from nonexercise related causes during the study and were not included in the analysis . The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program ( Phase 1 ) followed by 12 weeks of unsupervised home exercise ( Phase 2 ) . The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses . Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases . The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Two behavioral techniques were assessed to determine their effects on subjects ' adherence to unsupervised exercise . The subjects were 35 moderately fit persons who had just completed an adult fitness program ( AF group ) and 42 sedentary individuals who were recruited through the campus newspaper ( NEWS group ) . Participants were r and omly assigned to one of three conditions : ( a ) self-monitoring , ( b ) reinforcement supplied by another person , or ( c ) control . All subjects were given instructions on how to exercise and asked to exercise on their own for 18 weeks . Self-monitoring subjects kept written records of their exercise behavior , while reinforcement subjects verbally reported their exercise behavior to another person who periodically administered rewards . Pre- and posttreatment tests on the NEWS group revealed no significant treatment or interaction effects . However , the reinforcement group had an 11 % improvement in predicted max VO2 and a 9 bpm improvement in exercise heart rate compared to 7.8 % , 5 bpm for the self-monitoring ( SM ) group and 5.3 % , 6 bpm for the control group . T-tests indicated that reward and SM groups improved significantly on these variables , whereas the control group did not . SM ( M = 2.07 ) and reinforcement ( M = 2.29 ) groups reported a significantly higher frequency of exercise per week than the control ( M = 1.36 ) group . The AF subjects were able to maintain their fitness level ( with the exception of a small increase in body fat ) over the 18-week period . The behavioral interventions had little differential effect on adherence by AF subjects who were already regular exercisers OBJECTIVES To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis ( OA ) in older patients . DESIGN A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment , to check design assumptions and delivery processes . The main study was a r and omised controlled trial of the effectiveness of water-based exercise ( treatment ) compared with usual care ( control ) in older patients with hip and /or knee OA . The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments . SETTING Water exercise was delivered in public swimming pools in the UK . Physical function assessment s were carried out in established laboratory setting s. PARTICIPANTS 106 patients ( 93 women , 13 men ) over the age of 60 years with confirmed hip and /or knee OA took part in the preliminary study . A similar , but larger , group of 312 patients ( 196 women , 116 men ) took part in the main study , r and omised into control ( 159 ) and water exercise ( 153 ) groups . INTERVENTIONS Control group patients received usual care with quarterly semi-structured telephone interview follow-up only . The intervention in the main study lasted for 1 year , with a further follow-up period of 6 months . MAIN OUTCOME MEASURES Pain score on the Western Ontario and McMaster Universities OA index ( WOMAC ) . Additional outcome measures were included to evaluate effects on quality of life , cost-effectiveness and physical function measurements . RESULTS Short-term efficacy of water exercise in the management of lower limb OA was confirmed , with effect sizes ranging from 0.44 [ 95 % confidence interval ( CI ) 0.03 to 0.85 ] on WOMAC pain to 0.76 ( 95 % CI 0.33 to 1.17 ) on WOMAC physical function . Of 153 patients r and omised to treatment , 82 ( 53.5 % ) were estimated to have complied satisfactorily with their treatment at the 1-year point . This had declined to 28 ( 18 % ) by the end of the 6-month follow-up period , during which support for the intervention had been removed and those wishing to continue exercise had to pay their own costs for maintaining their exercise treatment . High levels of co-morbidity were recorded in both groups . Nearly two thirds of all patients had a significant other illness in addition to their OA . Fifty-four control and 53 exercise patients had hospital inpatient episodes during the study period . Water exercise remained effective in the main study but overall effect size was small , on WOMAC pain at 1 year , a reduction of about 10 % in group mean pain score . This had declined , and was non-significant , at 18 months . Mean cost difference estimates showed a saving in the water exercise group of pound123 - -175 per patient per annum and incremental cost-effectiveness ratios ranged from pound3838 to pound5951 per quality -adjusted life-year ( QALY ) . Net reduction in pain was achieved at a net saving of pound135 - -175 per patient per annum and the ceiling valuation of pound580 - -740 per unit of WOMAC pain reduction was favourably low . CONCLUSIONS Group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with lower limb OA , and may be a useful adjunct in the management of hip and /or knee OA . The water-exercise programme produced a favourable cost -- benefit outcome , using reduction in WOMAC pain as the measure of benefit . Further research is suggested into other similar public health interventions . Investigation is also needed into how general practice can best be supported to facilitate access to participants for research trials in healthcare , as well as an examination of the infrastructure and workforce capacities for physical activity delivery and the potential extent to which healthcare may be supported in this way . More detailed research is required to develop a better underst and ing of the types of exercise that will work for the different biomechanical subtypes of knee and hip OA and investigation is needed on access and environmental issues for physical activity programmes for older people , from both a provider and a participant perspective , the societal costs of the different approaches to the management of OA and longer term trends in outcome measures ( costs and effects ) OBJECTIVE To determine the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis . SETTING AND DESIGN A r and omized , single-blind clinical trial lasting 18 months conducted at 2 academic medical centers . PARTICIPANTS A total of 439 community-dwelling adults , aged 60 years or older , with radiographically evident knee osteoarthritis , pain , and self-reported physical disability . INTERVENTIONS An aerobic exercise program , a resistance exercise program , and a health education program . MAIN OUTCOME MEASURES The primary outcome was self-reported disability score ( range , 1 - 5 ) . The secondary outcomes were knee pain score ( range , 1 - 6 ) , performance measures of physical function , x-ray score , aerobic capacity , and knee muscle strength . RESULTS A total of 365 ( 83 % ) participants completed the trial . Overall compliance with the exercise prescription was 68 % in the aerobic training group and 70 % in the resistance training group . Postr and omization , participants in the aerobic exercise group had a 10 % lower adjusted mean ( + /- SE ) score on the physical disability question naire ( 1.71 + /- 0.03 vs 1.90 + /- 0.04 units ; P<.001 ) , a 12 % lower score on the knee pain question naire ( 2.1 + /- 0.05 vs 2.4 + /- 0.05 units ; P=.001 ) , and performed better ( mean [ + /- SE ] ) on the 6-minute walk test ( 1507 + /- 16 vs 1349 + /- 16 ft ; P<.001 ) , mean ( + /-SE ) time to climb and descend stairs ( 12.7 + /- 0.4 vs 13.9 + /- 0.4 seconds ; P=.05 ) , time to lift and carry 10 pounds ( 9.1 + /- 0.2 vs 10.0 + /- 0.1 seconds ; P<.001 ) , and mean ( + /-SE ) time to get in and out of a car ( 8.7 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P<.001 ) than the health education group . The resistance exercise group had an 8 % lower score on the physical disability question naire ( 1.74 + /- 0.04 vs 1.90 + /- 0.03 units ; P=.003 ) , 8 % lower pain score ( 2.2 + /- 0.06 vs 2.4 + /- 0.05 units ; P=.02 ) , greater distance on the 6-minute walk ( 1406 + /- 17 vs 1349 + /- 16 ft ; P=.02 ) , faster times on the lifting and carrying task ( 9.3 + /- 0.1 vs 10.0 + /- 0.16 seconds ; P=.001 ) , and the car task ( 9.0 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P=.003 ) than the health education group . There were no differences in x-ray scores between either exercise group and the health education group . CONCLUSIONS Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability , physical performance , and pain from participating in either an aerobic or a resistance exercise program . These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis OBJECTIVE To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis ( OA ) . Output:

Strong evidence was found for no long-term effectiveness on pain and self-reported physical function , moderate evidence for long-term effectiveness on patient global assessment of effectiveness , and conflicting evidence for observed physical function . For exercise programs with additional booster sessions , moderate evidence was found for long-term effectiveness on pain , self-reported physical function , and observed physical function . CONCLUSION The positive posttreatment effects of exercise therapy on pain and physical function in patients with OA of the hip and /or knee are not sustained in the long term . Long-term effectiveness was only found for patient global assessment of effectiveness . However , additional booster sessions after the treatment period positively influenced maintenance of beneficial posttreatment effects on pain and physical function in the long term

MS2_1shot531

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The P300 ( P3 ) event-related brain potential was elicited in a group of 50 children and young adults ( 4 - 20 years ) . A simple auditory task was employed in which subjects indicated with a finger movement when a r and omly occurring target tone ( high pitch ) was presented in a series of st and ard ( low pitch ) tones . The probability of the target tone was varied across conditions at 10 % , 30 % , or 50 % to assess possible developmental changes in P300 amplitude . Memory capacity was assessed with forward and reverse digit spans . Circumference of the head also was measured . P300 latency decreased with age , and P300 amplitude tended to become larger with age . Polynomial regression analyses revealed significant quadratic trends in these relationships , with changes leveling off for older subjects . Digit span and head circumference also were related curvilinearly to P300 values . Multiple regression analysis indicated that changes in age and memory span both predicted significant changes in P300 latency and amplitude . Target stimulus probability generally affected all subjects in a similar fashion , although the strength of the correlational relationships tended to decline with increases in probability . Developmental changes for the N1 , P2 , and N2 components from the st and ard stimuli also were obtained . The results are discussed in terms of previous P3 findings for children and their implication s for future studies A new off-line procedure for dealing with ocular artifacts in ERP recording is described . The procedure ( EMCP ) uses EOG and EEG records for individual trials in an experimental session to estimate a propagation factor which describes the relationship between the EOG and EEG traces . The propagation factor is computed after stimulus-linked variability in both traces has been removed . Different propagation factors are computed for blinks and eye movements . Tests are presented which demonstrate the validity and reliability of the procedure . ERPs derived from trials corrected by EMCP are more similar to a ' true ' ERP than are ERPs derived from either uncorrected or r and omly corrected trials . The procedure also reduces the difference between ERPs which are based on trials with different degrees of EOG variance . Furthermore , variability at each time point , across trials , is reduced following correction . The propagation factor decreases from frontal to parietal electrodes , and is larger for saccades than blinks . It is more consistent within experimental sessions than between sessions . The major advantage of the procedure is that it permits retention of all trials in an ERP experiment , irrespective of ocular artifact . Thus , studies of population s characterized by a high degree of artifact , and those requiring eye movements as part of the experimental task , are made possible . Furthermore , there is no need to require subjects to restrict eye movement activity . In comparison to procedures suggested by others , EMCP also has the advantage that separate correction factors are computed for blinks and movements and that these factors are based on data from the experimental session itself rather than from a separate calibration session This study demonstrates that the EEG phenotypes as described by Johnstone , Gunkelman & Lunt are identifiable EEG patterns with good inter-rater reliability . Furthermore , it was also demonstrated that these EEG phenotypes occurred in both ADHD subjects as well as healthy control subjects . The Frontal Slow and Slowed Alpha Peak Frequency and the Low Voltage EEG phenotype discriminated ADHD subjects best from controls ( however the difference was not significant ) . The Frontal Slow group responded to a stimulant with a clinical ly relevant decreased number of false negative errors on the CPT . The Frontal Slow and Slowed Alpha Peak Frequency phenotypes have different etiologies as evidence d by the treatment response to stimulants . In previous research Slowed Alpha Peak Frequency has most likely erroneously shown up as a frontal theta sub-group . This implies that future research employing EEG measures in ADHD should avoid using traditional frequency b and s , but dissociate Slowed Alpha Peak Frequency from frontal theta by taking the individual alpha peak frequency into account . Furthermore , the divergence from normal of the frequency b and s pertaining to the various phenotypes is greater in the clinical group than in the controls . Investigating EEG phenotypes provides a promising new way to approach EEG data , explaining much of the variance in EEGs and thereby potentially leading to more specific prospect i ve treatment outcomes Event-related brain potentials ( ERPs ) of 13 - 21-year-old autistic subjects and age-matched controls were elicited by auditory stimuli in a variation of orienting response paradigms . Unexpected , novel sounds ( bizarre concoctions of human , mechanical and computer sounds ) were r and omly inserted as probes in a sequence of expected , non-novel sounds ( the word ' me ' ) . In order to help ensure that both subject groups were attending to this stream of information , each subject was required to press a button to a specified target sound ( the word ' you ' ) also r and omly inserted in the sequence of expected non-novel sounds . The ERP results showed that in both groups , unexpected , novel probes and also targets evoked a different neurophysiological response than did expected , non-novel sounds . This suggests that the autistic group did not misperceive novel information as non-novel and were able to make simple classification decisions as accurately as normal controls . However , in the autistic group , there may be less ' processing ' of the novel probes and of targets : compared to the control group , the autistic group had smaller amplitudes of two long-latency components to novels and smaller P3b amplitudes to targets . The two components to novels were termed A/Pcz/300 ( A = auditory ; P = positive ; cz = electrode site of maximum amplitude ; 300 = latency in msec ) and A/Ncz/800 . In another sequence of sounds , subjects simply listened to frequently presented ' me ' sounds ( 90 % ) and infrequently presented ' you ' sounds ( 10 % ) . In this no-task condition , no differences between autistic and normal control subjects were found Output:

The P300 latency and amplitude follow a maturational path from childhood to adolescence , result ing in a period that marks a plateau , after which degenerative effects begin . / SIGNIFICANCE It is hypothesized that latency and amplitude index different aspects of brain maturation . The P300 latency possibly indexes neural speed or brain efficiency . The P300 amplitude might index neural power or cognitive re sources , which increase with maturation

MS2_1shot532

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This paper reports on the cost-effectiveness of pedometer-based versus time-based Green Prescriptions in improving physical activity and health-related quality of life ( EQ-5D ) in a r and omised controlled trial of 330 low-active , community-based adults aged 65 years and over . Costs , measured in $ NZ ( NZ$1=A$0.83 , December 2008 ) , comprised public and private health care costs plus exercise-related personal expenditure . Based on intention-to-treat data at 12-month follow up , the pedometer group showed a greater increase in weekly leisure walking ( 50.6 versus 28.1min for the time-based group , adjusted means , P=0.03 ) . There were no significant between-group differences in costs . The incremental cost-effectiveness ratios , for the pedometer-based versus time-based Green Prescription , per 30min of weekly leisure walking and per quality -adjusted life year were , ( i ) when including only community care costs , $ 115 and $ 3105 , ( ii ) when including only exercise and community care costs , $ 130 and $ 3500 , and ( iii ) for all costs , -$185 and -$4999 , respectively . The cost-effectiveness acceptability curves showed that the pedometer-based compared with the time-based Green Prescription was statistically cost-effective , for the above cost categories , at the following quality -adjusted life year thresholds : ( i ) $ 30000 ; ( ii ) $ 30500 ; and ( iii ) $ 16500 . The additional program cost of converting one sedentary adult to an active state over a 12-month period was $ 667 . The outcomes suggest the pedometer-based Green Prescription may be cost-effective in increasing physical activity and health-related quality of life over 12 months in previously low-active older adults Background The aim of the present study was to evaluate the cost-effectiveness of tailored print communication ( TPC ) , telephone motivational interviewing ( TMI ) , a combination of the two , and no intervention on two outcomes in adults aged 45 to 70 , half of them having hypertension : increasing the number of public health guidelines met for three behaviors ( physical activity and fruit and vegetable consumption ) , and impact on quality adjusted life years ( QALYs ) . Methods Participants ( n = 1,629 ) from 23 Dutch general practice s were r and omized into one of four groups , which received 4 TPCs , 4 TMIs , 2 of each ( combined ) , or no intervention ( control ) , respectively . The self-reported outcomes , measured at baseline and 73 weeks follow-up ( 7 months after the last intervention component ) , were difference in total number of guidelines met at follow-up compared to baseline , and number of QALYs experienced over 73 weeks . The costs of implementing the intervention were estimated using a bottom-up approach . Results At 73 weeks follow-up participants showed increased adherence with 0.62 ( TPC ) , 0.40 ( TMI ) , 0.50 ( combined ) , and 0.26 ( control ) guidelines compared to baseline , and experienced 1.09 , 1.08 , 1.08 , and 1.07 QALYs , respectively . The costs for the control group were considered to be zero . TMI was more expensive ( € 107 per person ) than both the combined intervention ( € 80 ) and TPC ( € 57 ) . The control condition was most cost-effective for lower ceiling ratios , while TPC had the highest probability of being most cost-effective for higher ceiling ratios ( more than € 160 per additional guideline met , and € 2,851 for each individual QALY ) . Conclusions For low society 's willingness to pay , the control group was most cost-effective for the number of QALYs experienced over 73 weeks . This also applied to the increase in the number of guidelines met at lower ceiling ratios , whereas at higher ceiling ratios , TPC had a higher probability of being more cost-effective than the TMI , combined or control conditions . This also seemed to apply for QALYs experienced over 73 weeks . More research is needed on the long-term efficacy of both TPC and TMI , as well as on how to increase their cost-effectiveness . Trial registration Dutch Trial Register This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity ( PA ) and nutrition . In total , 924 participants enrolled in a 2-year cluster r and omized controlled trial , with departments ( n = 74 ) within companies ( n = 6 ) as the unit of r and omization . The intervention was compared with a st and ard programme consisting of a physical health check with face-to-face advice and personal feedback on a website . The intervention consisted of several additional website functionalities : action-oriented feedback , self-monitoring , possibility to ask questions and monthly e-mail messages . Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake . Secondary outcomes were self-perceived health , obesity , elevated blood pressure , elevated cholesterol level and maximum oxygen uptake . Direct and indirect costs were calculated from a societal perspective , and a process evaluation was performed . Of the 924 participants , 72 % participated in the first and 60 % in the second follow-up . No statistically significant differences were found on primary and secondary outcomes , nor on costs . Average direct costs per participant over the 2-year period were € 376 , and average indirect costs were € 9476 . In conclusion , no additional benefits were found in effects or cost savings . Therefore , the programme in its current form can not be recommended for implementation BACKGROUND More evidence is needed on the potential role of ' booster ' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary population s. OBJECTIVES To determine whether objective ly measured physical activity , 6 months after a brief intervention , is increased in those receiving physical activity ' booster ' consultations delivered in a motivational interviewing ( MI ) style , either face to face or by telephone . DESIGN Three-arm , parallel-group , pragmatic , superiority r and omised controlled trial with nested qualitative research fidelity and geographical information systems and health economic sub studies . Treatment allocation was carried out using a web-based simple r and omisation procedure with equal allocation probabilities . Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only . SETTING Deprived areas of Sheffield , UK . PARTICIPANTS Previously sedentary people , aged 40 - 64 years , living in deprived areas of Sheffield , UK , who had increased their physical activity levels after receiving a brief intervention . INTERVENTIONS Participants were r and omised to the control group ( no further intervention ) or to two sessions of MI , either face to face ( ' full booster ' ) or by telephone ( ' mini booster ' ) . Sessions were delivered 1 and 2 months post-r and omisation . MAIN OUTCOME MEASURES The primary outcome was total energy expenditure ( TEE ) per day in kcal from 7-day accelerometry , measured using an Actiheart device ( CamNtech Ltd , Cambridge , UK ) . Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment . An estimate of the per-participant intervention costs , re source use data collected by question naire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective . An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness . RESULTS In total , 282 people were r and omised ( control = 96 ; mini booster = 92 , full booster = 94 ) of whom 160 had a minimum of 4 out of 7 days ' accelerometry data at 3 months ( control = 61 , mini booster = 47 , full booster = 52 ) . The mean difference in TEE per day between baseline and 3 months favoured the control arm over the combined booster arm but this was not statistically significant ( -39 kcal , 95 % confidence interval -173 to 95 , p = 0.57 ) . The autonomy-enabled MI communication style was generally acceptable , although some participants wanted a more paternalistic approach and most expressed enthusiasm for monitoring and feedback components of the intervention and research . Full boosters were more popular than mini boosters . Practitioners achieved and maintained a consistent level of MI competence . Walking distance to the nearest municipal green space or leisure facilities was not associated with physical activity levels . Two alternative modelling approaches both suggested that neither intervention was likely to be cost-effective . CONCLUSIONS Although some individuals do find a community-based , brief MI ' booster ' intervention supportive , the low levels of recruitment and retention and the lack of impact on objective ly measured physical activity levels in those with adequate outcome data suggest that it is unlikely to represent a clinical ly effective or cost-effective intervention for the maintenance of recently acquired physical activity increases in deprived middle-aged urban population s. Future research with middle-aged and relatively deprived population s should explore interventions to promote physical activity that require less proactive engagement from individuals , including environmental interventions . STUDY REGISTRATION Current Controlled Trials IS RCT N56495859 , Clinical Trials.gov NCT00836459 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 18 , No. 13 . See the NIHR Journals Library website for further project information OBJECTIVE To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults . The study took place in Providence , Rhode Isl and between the years 2000 and 2004 . METHODS Two hundred and thirty-nine participants were r and omized to Phone , Print or a contact control . Phone and Print groups were mailed regular surveys regarding their level of physical activity , motivational readiness and self-efficacy . Surveys were scanned by a computer expert system to generate feedback reports . Phone group participants received feedback by telephone . Print group participants received feedback by mail . The contact control group received mailings unrelated to physical activity . Intervention costs were assessed prospect ively , from a payer perspective . Physical activity was measured using the 7-day Physical Activity Recall . Ambulatory health service use was assessed via monthly surveys . RESULTS The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle . CONCLUSION The Print intervention provides an efficient approach to increasing physical activity . Research is needed to determine the cost-effectiveness of the intervention in a more diverse population , within the context of the health service delivery system and over a longer period of time Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more exercise sessions . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement Abstract Objective : To assess the long term effectiveness of the “ green prescription ” programme , a clinician based initiative in general practice that provides counselling on physical activity . Design : Cluster r and omised controlled trial . Practice s were r and omised before systematic screening and recruitment of patients . Setting : 42 rural and urban general practice s in one region of New Zeal and . Subjects : All sedentary 40–79 year old patients visiting their general practitioner during the study 's recruitment period . Intervention : General practitioners were prompted by the patient to give oral and written advice on physical activity during usual consultations . Exercise specialists continued support by telephone and post . Control patients received usual care . Main outcome measures : Change in physical activity , quality of life ( as measured by the “ short form 36 ” ( SF-36 ) question naire ) , cardiovascular risk ( Framingham and D'Agostino equations ) , and blood pressure over a 12 month period . Results : 74 % ( 117/159 ) of general practitioners and 66 % ( 878/1322 ) of screened eligible patients participated in the study . The follow up rate was 85 % ( 750/878 ) . Mean total energy expenditure increased by 9.4 kcal/kg/week ( P=0.001 ) and leisure exercise by 2.7 kcal/kg/week ( P=0.02 ) or 34 minutes/week more in the intervention group than in the control group ( P=0.04 ) . The proportion of the intervention group undertaking 2.5 hours/ Output:

CONCLUSIONS Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care . Given the commonly accepted thresholds , they appear to be cost-effective on the whole , although there is notable variation between studies

MS2_1shot533

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To evaluate the efficacy of short ( 5 or 6 mm long ) dental implants vs 10 mm or longer implants placed in crestally lifted sinuses . MATERIAL S AND METHODS Twenty partially edentulous patients with 5 to 7 mm of residual crestal height and at least 7 mm thickness below the maxillary sinuses as measured on computed tomography scans were r and omised according to a parallel group design to receive either one to two 5 or 6 mm long implants ( 10 patients ) or 10 mm long implants ( 10 patients ) after crestal sinus lifting and grafting with anorganic bovine bone . Implants were left to heal submerged for 4 months and were loaded with reinforced acrylic provisional prostheses , replaced , after 4 months , by definitive provisionally cemented or screw-retained metal-ceramic or metal-composite prostheses . Outcome measures were : prosthesis and implant failures , any complications , radiographic peri-implant marginal bone level changes , and patient 's satisfaction assessed by blinded assessors , when possible . All patients were followed up to 3 years after loading . RESULTS Two patients from the augmented group dropped out after the 1-year follow-up . No implant or prosthesis failure occurred . One short implant patient was affected by two complications vs one complication in the long implant group . There was no difference for patients experiencing complications between the two groups ( difference in proportions = -0.03 % ; 95%CI : -0.32 to 0.27 ; P = 1.000 ) . Short implants lost 0.89 ± 0.25 mm and long implants lost 1.08 ± 0.29 mm of peri-implant marginal bone 3 years after loading , the difference between the two groups being not statistically significant ( difference = -0.19 mm ; 95%CI : -0.46 to 0.09 ; P = 0.165 ) . All patients were fully or partially satisfied with function and fully satisfied with aesthetics . CONCLUSIONS Both techniques achieved excellent results and no differences were observed between prostheses supported by one to two 5 or 6 mm long implants vs 10 mm long in posterior atrophic maxillae up to 3 years after loading ; therefore it is up to clinicians to decide which procedure to use , although longer follow-ups with larger patient population s are needed to better underst and if one of these procedures could be more effective in the long-term . Conflict of interest statement : this study was partially supported by Zimmer Biomet . However , data property belonged to the authors , and by no means did the manufacturer interfere with the conduct of the trial or the publication of its results PURPOSE To compare the clinical outcome of immediately loaded cross-arch maxillary prostheses supported by zygomatic implants vs conventional implants placed in augmented bone . MATERIAL S AND METHODS A total of 71 edentulous patients with severely atrophic maxillas , who did not have sufficient bone volume to place dental implants or when it was possible to place only two implants in the front area ( minimal diameter 3.5 mm and length of 8 mm ) and less than 4.0 mm of bone height subantrally , were r and omised according to a parallel group design . They ( 35 patients ) received zygomatic implants to be loaded immediately vs grafting with a xenograft , followed , after 6 months of graft consolidation , by the placement of six to eight conventional dental implants , submerged for 4 months ( 36 patients ) . To be loaded immediately , zygomatic implants had to be inserted with an insertion torque superior to 40 Ncm . Screw-retained , metal-reinforced , acrylic provisional prostheses were provided to be replaced by definitive Procera Implant Bridge Titanium prostheses ( Nobel Biocare , Göteborg , Sweden ) with ceramic or acrylic veneer material s 4 months after initial loading . Outcome measures were : prosthesis , implant and augmentation failures , any complications , quality of life ( OHIP-14 ) , the number of days that patients experienced total or partial impaired activity , time to function , and number of dental visits , assessed by independent assessors . Patients were followed up to 4 months after loading . RESULTS No augmentation procedure failed . Three patients dropped out from the augmentation group . Six prostheses could not be delivered or failed in the augmentation group vs one prosthesis in the zygomatic group , the difference being statistically significant ( difference in proportions = 15.32 % ; P = 0.04 ; 95 % CI : 0.23 to 31.7 ) . Eight patients lost 35 implants in the augmentation group vs three implants in one patient from the zygomatic group , the difference being statistically significant ( difference in proportions = 21.38 % ; P = 0.001 ; 95 % CI : 3.53 to 39.61 ) . In total , 14 augmented patients were affected by 20 complications vs 26 zygomatic patients ( 35 complications ) , the difference being statistically significant ( difference in proportions = 31.87 % ; P = 0.008 ; 95 % CI : 6.48 to 53.37 ) . The OHIP-14 score was 3.68 ± 5.41 for augmented patients and 4.97 ± 5.79 for zygomatic patients , with no statistically significant differences between groups ( mean difference = 1.29 ; 95%CI -1.60 to 4.18 ; P = 0.439 ) . Both groups had significantly improved OHIP-14 scores from before rehabilitation ( P < 0.001 for both augmented and zygomatic patients ) . The number of days of total infirmity was , on average , 7.42 ± 3.17 for the augmented group and 7.17 ± 1.96 for the zygomatic group , the difference not being statistically significant ( mean difference = -0.25 ; 95 % CI : -1.52 to 1.02 ; P = 0.692 ) . Days of partial infirmity were on average 14.24 ± 4.64 for the augmented group and 12.17 ± 3.82 for the zygomatic group , the difference being statistically significant ( mean difference = -2.07 ; 95 % CI : -4.12 to -0.02 ; P = 0.048 ) . The mean number of days to have a functional prosthesis was 444.32 ± 207.86 for augmented patients and 1.34 ± 2.27 for zygomatic patients , the difference being statistically significant ( mean difference = -442.9 ; 95 % CI : -513.10 to -372.86 ; P < 0.001 ) . The average number of dental visits was 16.79 ± 10.88 for augmented patients and 12.58 ± 5.21 for zygomatic patients , the difference not being statistically significant ( mean difference = -4.21 ; 95 % CI -8.48 to 0.06 ; P = 0.053 ) . CONCLUSIONS Preliminary 4-months post-loading data suggest zygomatic implants were associated with statistically significantly less prosthetic ( one vs six patients ) and implant failures ( one patient lost three implants versus 35 implants in eight patients ) as well as time needed to functional loading ( 1.3 days vs 444.3 days ) when compared with augmentation procedures and conventionally loaded dental implants . Even if more complications were reported for zygomatic implants , which were solved spontaneously or could be h and led , zygomatic implants proved to be a better rehabilitation modality for severely atrophic maxillae . Long-term data are essential to confirm or dispute these preliminary results . Conflict of interest statement : This study was originally supported by Nobel Biocare , the manufacturer of the implants , and the provisional and definitive prosthetic components used in this study , which were provided free for the patients . However , before any results were known , Nobel Biocare withdrew the financial support and recruitment had to be stopped . Tecnoss ( Giaveno , Torino , Italy ) kindly donated the bone substitutes and the membranes , whereas Global D ( Brignais , France ) donated the osteo synthesis screws . Data property belonged to the authors and by no means did the manufacturers interfere with the publication of the results PURPOSE To evaluate whether 4.0 mm short dental implants could be an alternative to augmentation with xenographs in the maxilla and placement of at least 10.0 mm long implants in posterior atrophic jaws . MATERIAL S AND METHODS A group of 40 patients with atrophic posterior ( premolar and molar areas ) m and ibles with 5.0 mm to 6.0 mm bone height above the m and ibular canal and 40 patients with atrophic maxillas having 4.0 mm to 5.0 mm below the maxillary sinus , were r and omised according to a parallel group design to receive between one and three 4.0 mm long implants or one to three implants of at least 10.0 mm long in augmented bone , at two centres . All implants had a diameter of 4.0 mm or 4.5 mm . M and ibles were vertically augmented with inter-positional equine bone blocks and resorbable barriers . Implants were placed 4 months after the inter-positional grafting . Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers , and implants were placed simultaneously . Implants were not submerged and were loaded after 4 months with provisional screw-retained reinforced acrylic restorations replaced after another 4 months by definitive screw-retained metal-composite prostheses . Patients were followed up to 1 year post-loading . Outcome measures were : prosthesis and implant failures , any complication , and peri-implant marginal bone level changes . RESULTS Three patients dropped out ; one from the maxillary augmented group , one from the m and ibular augmented group , and one from the maxillary short implant group . In six augmented m and ibles ( 30 % ) it was not possible to place implants of at least 10.0 mm , so shorter implants were placed instead . In m and ibles , one implant from the augmented group failed vs two 4.0 mm implants in two patients from the short implant group . In maxillae , three short implants failed in two patients vs seven long implants in four patients ( two long implants and one short implant dropped into the maxillary sinus ) . Two prostheses on short implants ( one m and ibular and one maxillary ) were placed at a later stage because of implant failures , vs six prostheses ( one m and ibular and five maxillary ) at augmented sites ( one m and ibular prosthesis not delivered , three maxillary prostheses delivered with delays , one not delivered , and one failed ) at augmented sites . In particular , three patients in the augmented group ( one m and ible and two maxillae ) were not wearing a prosthesis . There were no statistically significant differences in implant failures ( P ( chi-square test ) = 0.693 ; difference in proportion = 0.03 ; CI 95 % -0.11 to 0.17 ) or prostheses failures ( P ( chi-square test ) = 0.126 ; difference in proportion = 0.10 ; CI 95 % -0.03 to 0.24 ) . At m and ibular sites , nine augmented patients were affected by complications vs two patients treated with short implants ( P ( chi-square test ) = 0.01 ; difference in proportion = 0.37 ; CI 95 % 0.11 to 0.63 ) , the difference being statistically significant . No significant differences were found for maxillae : nine sinus-lifted patients vs four short implant patients were affected by complications ( P ( chi-square test ) = 0.091 ; difference in proportion = 0.25 ; CI 95 % -0.03 to 0.53 ) . At 1-year post-loading , average peri-implant bone loss was 0.51 mm at 4 mm long m and ibular implants , 0.77 mm at 10 mm or longer m and ibular implants , 0.63 mm at short maxillary implants and 0.72 mm at long maxillary implants . The difference was statistically significant in m and ibles ( mean difference -0.26 mm , 95 % CI -0.39 to -0.13 , P ( ANCOVA ) < 0.001 ) , but not in maxillae ( mean difference -0.09 mm , 95 % CI -0.24 to 0.05 , P ( ANCOVA ) = 0.196 ) . CONCLUSIONS One year after loading 4.0 mm long implants achieved similar results , if not better , than longer implants in augmented jaws , but were affected by fewer complications . Short implants might be a preferable choice over bone augmentation , especially in m and ibles , since the treatment is less invasive , faster , cheaper , and associated with less morbidity . However , 5 to 10 years post-loading data are necessary before making reliable recommendations PURPOSE To evaluate whether 5.0 × 5.0 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants of at least 10.0 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws . MATERIAL S AND METHODS Forty patients with atrophic posterior ( premolar and molar areas ) m and ibles with 5.0 mm to 7.0 mm bone height above Output:

Five years after loading , prosthetic and implant failures were similar between the two interventions , but complications and peri-implant marginal bone loss were higher and more severe at longer implants placed in vertically augmented m and ibles . However in the meantime short implants could be the preferable option

MS2_1shot534

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective To investigate whether an internet based , nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinical ly manifest vascular disease . Design Prospect i ve r and omised controlled trial . Setting Multicentre trial in secondary and tertiary healthcare setting . Participants 330 patients with a recent clinical manifestation of atherosclerosis in the coronary , cerebral , or peripheral arteries and with at least two treatable risk factors not at goal . Intervention Personalised website with an overview and actual status of patients ’ risk factors and mail communication via the website with a nurse practitioner for 12 months ; the intervention combined self management support , monitoring of disease control , and drug treatment . Main outcome measures The primary endpoint was the relative change in Framingham heart risk score after 1 year . Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor . Results Participants ’ mean age was 59.9 ( SD 8.4 ) years , and most patients ( n=246 ; 75 % ) were male . After 1 year , the relative change in Framingham heart risk score of the intervention group compared with the usual care group was −14 % ( 95 % confidence interval −25 % to −2 % ) . At baseline , the Framingham heart risk score was higher in the intervention group than in the usual care group ( 16.1 ( SD 10.6 ) v 14.0 ( 10.5 ) ) , so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score . This produced a relative change of −12 % ( −22 % to −3 % ) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and −8 % ( −18 % to 2 % ) adjusted for the baseline score . Of the individual risk factors , a difference between groups was observed in low density lipoprotein cholesterol ( −0.3 , −0.5 to −0.1 , mmol/L ) and smoking ( −7.7 % , −14.9 % to −0.4 % ) . Some other risk factors tended to improve ( body mass index , triglycerides , systolic blood pressure , renal function ) or tended to worsen ( glucose concentration , albuminuria ) . Conclusion An internet based , nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease . Trial registration Clinical trials NCT00785031 BACKGROUND This article is the result of a debate at the European Journal of Orthodontics Open Session in 2013 in Reykjavik , Icel and . OBJECTIVE The aim of this article is to highlight some of the strengths and weakness of clinical orthodontic research , with particular emphasis on r and omized controlled trials ( RCT ) . The ultimate aim of improving clinical orthodontic research in general . DESIGN This article is organized into two sections with arguments for and against RCTs . The background s to evidence -based evaluation and the level or quality of evidence in trials are discussed . The article emphasises what makes high quality clinical research , and gives practical advice including examples of tips and potential pitfalls for those undertaking clinical research . RESULTS AND CONCLUSION The overriding message is constructive and it is hoped that the article serves as an aid in evaluating , design ing , conducting , and reporting clinical research AIMS To describe and compare the outcomes of a nurse practitioner-managed cardiac surgery follow-up model of care with the st and ard model of primary care provider follow-up for coronary artery bypass graft surgery patients . BACKGROUND Advances in healthcare have had a favourable impact on length of stay following cardiac surgery ; however , the shorter length of stay has not been accompanied by enhanced support to bridge the gap between acute care and the community setting . DESIGN Prospect i ve ( 2009 - 2010 ) r and omized study . METHODS Elective cardiac surgery patients ( N = 200 ) were r and omly assigned to the nurse practitioner follow-up intervention or to the st and ard model of follow-up care . The main outcomes were health-related quality of life , patient satisfaction , symptoms , and health re source use . Outcome data were elicited via telephone interviews at 2 and 6 weeks postdischarge . RESULTS Baseline differences between the two groups were non-significant ; however , at 2 weeks postdischarge , the intervention group reported significantly fewer symptoms and higher physical functioning status . At 2 and 6 weeks postdischarge , the intervention group was significantly more satisfied with the amount of help , as well as the quality of the services received . Differences in healthcare re source use were not statistically significant . CONCLUSION This evidence suggests that the nurse practitioner-managed model of follow-up care effectively bridges the gap between institutional and primary care in the cardiac surgery population BACKGROUND High dem and for acute care nurse practitioners ( ACNPs ) in Canadian postoperative cardiac surgery setting s has outpaced method ologically rigorous research to support the role . PURPOSE To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian , university-affiliated , tertiary care hospital . METHODS Patients scheduled for urgent or elective coronary artery bypass and /or valvular surgery were r and omly assigned to either ACNP-led ( n=22 ) or hospitalist-led ( n=81 ) postoperative care . Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon . Outcome variables included length of hospital stay , hospital readmission rate , postoperative complications , adherence to follow-up appointments , attendance at cardiac rehabilitation and both patient and health care team satisfaction . RESULTS Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis ( p < or = 0.01 ) , and had undergone more complicated surgical procedures ( p < or = 0.01 ) . After discharge , more patients in the hospitalist-led group had visited their family doctor within a week ( p < or = 0.02 ) and measures of satisfaction relating to teaching , answering questions , listening and pain management were higher in the ACNP-led group . CONCLUSION / IMPLICATION S Although challenges in recruitment yielded a lower than anticipated sample size , this study contributes to our knowledge of the ACNP role in postoperative cardiac surgery . Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care Objective To assess the cost-effectiveness of an internet-based , nurse-led vascular risk factor management programme in addition to usual care compared with usual care alone in patients with a clinical manifestation of a vascular disease . Design Cost-effectiveness analysis alongside a r and omised controlled trial ( the Internet-based vascular Risk factor Intervention and Self-management ( IRIS ) study ) . Setting Multicentre trial in a secondary and tertiary healthcare setting . Participants 330 patients with a recent clinical manifestation of atherosclerosis in the coronary , cerebral , or peripheral arteries and with ≥2 treatable vascular risk factors not at goal . Intervention The intervention consisted of a personalised website with an overview and actual status of patients ’ vascular risk factors , and mail communication with a nurse practitioner via the website for 12 months . The intervention combined self-management support , monitoring of disease control and pharmacotherapy . Main outcome measures Societal costs , quality -adjusted life-years ( QALYs ) and incremental cost-effectiveness . Results Patients experienced equal health benefits , that is , 0.86 vs 0.85 QALY ( intervention vs usual care ) at 1 year . Adjusting for baseline differences , the incremental QALY difference was −0.014 ( 95 % CI −0.034 to 0.007 ) . The intervention was associated with lower total costs ( € 4859 vs € 5078 , difference € 219 , 95 % CI −€2301 to € 1825 ) . The probability that the intervention is cost-effective at a threshold value of € 20 000/QALY , is 65 % . At mean annual cost of € 220 per patient , the intervention is relatively cheap . Conclusions An internet-based , nurse-led intervention in addition to usual care to improve vascular risk factors in patients with a clinical manifestation of a vascular disease does not result in a QALY gain at 1 year , but has a small effect on vascular risk factors and is associated with lower costs . Trial registration number NCT00785031 This study reports results of the 2-year follow-up phase of a r and omized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice . In the sample of 406 adults , no differences were found between the groups in health status , disease-specific physiologic measures , satisfaction or use of specialist , emergency room or inpatient services . Physician patients averaged more primary care visits than nurse practitioner patients . The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians Increasing dem and to deliver and document therapeutic and preventive care sharpens the need for disease management strategies that accomplish these goals efficiently while preserving quality of care . The purpose of this study was to compare selected outcomes for a new chronic disease management program involving a nurse practitioner - physician team with those of an existing model of care . One hundred fifty-seven patients with hypertension and diabetes mellitus were r and omly assigned to their primary care physician and a nurse practitioner or their primary care physician alone . Costs for personnel directly involved in patient management , calculated from hourly rates and encounter time with patients , and pre- and post- study glycosylated hemoglobin ( HbA1c ) , high-density lipoprotein cholesterol ( HDL-c ) , satisfaction with care and health-related quality of life ( HRQoL ) were assessed . Although 1-year costs for personnel were higher in the team-treated group , participants experienced significant improvements in mean HbA1c ( − 0.7 % , p = 0.02 ) and HDL-c ( + 2.6 mg dL − 1 , p = 0.02 ) . Additionally , satisfaction with care improved significantly for team-treated subjects in several sub-scales whereas the mean change over time in HRQoL did not differ significantly between groups . This study demonstrates the value of a complementary team approach to chronic disease management in improving patient-derived and clinical outcomes at modest incremental costs BACKGROUND Telemonitoring has been advocated as a way of decreasing costs and improving outcomes , but no study has looked at true Medicare payments and 30-day readmission rates in a r and omized group of well treated patients . OBJECTIVE The aim of this work was to analyze Medicare cl aims data to identify effects of home telemonitoring on medical costs , 30-day rehospitalization , mortality , and health-related quality of life . METHODS A total of 204 subjects were r and omized to usual-care and monitored groups and evaluated with the SF-36 and Minnesota Living With Heart Failure Question naire ( MLHF ) . Hospitalizations , Medicare payments , and mortality were also assessed . Monitored subjects transmitted weight , blood pressure , and heart rate , which were monitored by an experienced heart failure nurse practitioner . RESULTS Subjects were followed for 802 ± 430 days ; 75 subjects in the usual-care group ( 316 hospitalizations ) and 81 in the monitored group ( 327 hospitalizations ) were hospitalized at least once ( P = .51 ) . There were no differences in Medicare payments for inpatient or emergency department visits , and length of stay was not different between groups . There was no difference in 30-day readmissions ( P = .627 ) or mortality ( P = .575 ) . Scores for SF-36 and MLHF improved ( P < .001 ) over time , but there were no differences between groups . The percentage of patients readmitted within 30 days was lower with telemonitoring for the 1st year , but this did not persist . CONCLUSIONS Telemonitoring did not result in lower total costs , decreased hospitalizations , improved symptoms , or improved mortality . A decrease in 30-day readmission rates for the 1st year did not result in decreased total cost or better outcomes Low levels of statin adherence may compromise treatment outcomes . The aim of this study was to investigate whether nurse-led cardiovascular risk-factor counseling could improve statin adherence and lipid levels without increasing patients ' anxiety . Patients with indications for statin therapy for primary or secondary prevention of cardiovascular disease were r and omly assigned to receive routine care or extended care ( EC ) at baseline and at months 3 , 9 , and 18 . Patients in the EC group received a personalized risk-factor passport , showing modifiable and unmodifiable individual risk factors and a graphical presentation of their calculated absolute 10-year cardiovascular disease risk as well as the target risk that could be reached if all modifiable risk factors were optimally treated . Lipid levels were assessed at each visit . Carotid intima-media thickness was measured at baseline and at month 18 . Adherence , anxiety , quality of life , symptoms , and smoking status were assessed using a self-administered question naire at each visit . A total of 201 patients were included in the study . Statin adherence was significantly higher ( p < 0.01 ) and anxiety was significantly lower ( p < 0.01 ) in the EC Output:

There was no statistical difference between nurse practitioner-led care and usual care for 30-day readmissions , health related quality of life and length of stay . IMPACT Low to moderate quality evidence was identified with no statistically significant associated outcomes of care .

MS2_1shot535

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Prevention of relapse following depression is a pressing research problem . The authors tested the efficacy of the tricyclic antidepressant amitriptyline and psychotherapy , alone and in combination , in preventing the relapse of 150 neurotic depressed female patients . They found that patients receiving amitriptyline and little psychotherapy had a 12-percent relapse rate , compared to a 16-percent rate for those receiving more psychotherapy and no medication . There was no significant difference between drug therapy alone or drug therapy in combination with psychotherapy . However , psychotherapy was beneficial to patients with problems of social adjustment and interpersonal relations . The need for further research and implication s for treatment are discussed A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were r and omly selected for one of four consultations : a consultation conducted in a " positive manner , " with and without treatment , and a consultation conducted in a " non-positive manner , " called a negative consultation , with and without treatment . Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups . Similarly , 64 % of those receiving a positive consultation got better , compared with 39 % of those who received a negative consultation ( p = 0.001 ) and 53 % of those treated got better compared with 50 % of those not treated ( p = 0.5 ) OBJECTIVE To investigate the effects of functional electrical stimulation ( FES ) on the improvement of motor and walking ability of the lower extremities of the patients with acute stroke . METHODS Forty-six patients with stroke ( including cerebral infa rct ion and hemorrhage ) , aged 71 + /- 8 ( 45 - 84 ) , hospitalized within 2 weeks ( 9 + /- 4 days ) after the onset , matched with one another in the baseline measurements before treatment , were assigned r and omly into 3 groups : FES group ( n = 13 ) , receiving st and ard rehabilitation combined with FES 30 minutes per day , 5 days per week for 3 weeks , placebo stimulation group ( n = 15 ) receiving st and ard rehabilitation combined with the installment of the FES apparatus , operated in the same manner as mentioned above , however , without real electric stimulation , and control group ( n = 13 ) , receiving st and ard rehabilitation alone . The score of the composite spasticity scale ( CSS ) was measured , electromyography was conducted to measure the maximum isometric voluntary contraction ( MIVC ) of the ankle dorsi-flexors and plantar-flexors , and walking ability by the test of timed " Up and Go " before treatment , weekly during the 3-week treatment , and 8 weeks after the onset of stroke . RESULTS After 3 weeks of treatment , the percentage of CSS score of the FES group was 31 % + /- 35 % , significantly lower than those of the placebo and control groups ( 50 % + /- 88 % and 65 % + /- 65 % respectively , both P < 0.05 ) ; the ankle dorsiflexion torque of MIVC of the FES group was 9 Nm + /- 5 Nm , significantly higher than those of the placebo and control groups ( 5 Nm + /- 3 Nm and 4 Nm + /- 5 Nm respectively , both P < 0.05 ) , and the electromyogram co-contraction ratio of the FES group was 8 % + /- 5 % , significantly lower than those of the placebo and control groups ( 27 % + /- 26 % and 28 % + /- 19 % respectively , both P < 0.05 ) . The time needed to recover the walking ability after the stroke onset of the FES group was 18 + /- 8 days , shorter by 2 approximately 3 days than those of the placebo and control groups ( 20 + /- 7 and 21 + /- 8 days respectively ) . The percentage of the patients able to walk with the help of a stick 3 weeks after treatment of the FES group was 85 % , significantly higher than those of the placebo and control groups ( 60 % and 46 % respectively , both P < 0.05 ) . 84.6 % of the patients of the FES group returned home , a percentage significantly higher than those of the placebo and control groups ( 53 % and 46 % respectively , both P < 0.05 ) . CONCLUSION FES , plus st and ard rehabilitation , is effective in improving the motor and walking ability of the patients with acute stroke , to the degree that most patients are recovered to be able to return home A prospect i ve , r and omized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation . The study was double-blinded to the degree that the method ologies allowed . One hundred and fifty healthy adults undergoing elective surgery were allocated at r and om to five groups : EMLA cream , ethyl chloride spray , intracutaneous infiltration with 2 % lidocaine , placebo cream and no treatment . Venipuncture was performed with a 18 G cannula on the dorsal side of the h and . Puncture pain and pain caused by the topical treatment itself were measured using a visual analogue scale ( VAS , range : 0 - 100 mm ) . Haemodynamic response , difficulties in performing the puncture and side-effects were recorded . All analgesic techniques were well tolerated . Haemodynamic response and degree of puncture difficulty showed no differences among the groups . Puncture pain ( median mrnVAS ) following infiltration ( 1.0 ) and EMLA ( 10.0 ) was significantly lower than no treatment ( 30.0 ) or placebo ( 30.0 ) . The benefit of local infiltration was altered by injection pain ( 11.5 ) . Spray did not significantly lower puncture pain ( 26.5 ) and , in addition , was associated with discomfort ( 10.5 ) . In adults , EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation . Local lidocaine infiltration is impaired by applicational pain , whereas spraying the puncture site with ethyl chloride has no analgesic benefit BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy Objective : To assess the efficacy of an orally administered antioxidant dietary supplement for managing marginal dry eye . Design : A prospect i ve , r and omised , placebo controlled trial with cross-over . Setting : Eye Clinic , Department of Vision Sciences , Glasgow Caledonian University . Subjects : Forty marginal dry eye sufferers composed of 30 females and 10 males ( median age 53 y ; range 38–69 y ) . Interventions : Baseline assessment s were made of tear volume sufficiency ( thread test ) , tear quality ( stability ) , ocular surface status ( conjunctival impression cytology ) and dry eye symptoms ( question naire ) . Each subject was administered courses of active treatment , placebo and no treatment , in r and om order for 1 month each and results compared to baseline . Results : Tear stability and ocular surface status were significantly improved following active treatment ( P<0.05 ) . No changes from baseline were detected following administration of placebo and no treatment ( P>0.05 ) . Absolute increase in tear stability correlated with absolute change in goblet cell population density . Tear volume was not improved following any treatment period and dry eye symptom responses were subject to placebo effect . Conclusions : Oral antioxidants improved both tear stability and conjunctival health , although it is not yet understood whether increased ocular surface health mediates increased tear stability or vice versa . Sponsors : This study was supported by a PhD scholarship funded by the Department of Vision Sciences , Glasgow Caledonian University , Scotl and . Antioxidant supplements and placebos were kindly donated by Vitabiotics . European Journal of Clinical Nutrition ( 2001 ) 55 , Background and Purpose — The effectiveness of functional electrical stimulation ( FES ) has been investigated in chronic hemiplegia . The present study examines whether FES , given during acute stroke , was more effective in promoting motor recovery of the lower extremity and walking ability than st and ard rehabilitation alone . Methods — Forty-six subjects , 70.9±8.0 years old and 9.2±4.1 days after stroke , were assigned r and omly to 1 of 3 groups receiving st and ard rehabilitation with FES or placebo stimulation or alone ( control ) . FES was applied 30 minutes and placebo stimulation 60 minutes , 5 days per week for 3 weeks . Outcome measurements included composite spasticity score , maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors , and walking ability . They were recorded before treatment , weekly during the 3-week treatment , and at week 8 after stroke . Results — No significant differences were found in the baseline measurements . After 3 weeks of treatment , there was a significant reduction in the percentage of composite spasticity score , and a significant improvement in the ankle dorsiflexion torque , accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group , when compared with the other 2 groups ( P<0.05 ) . All subjects in the FES group were able to walk after treatment , and 84.6 % of them returned home , in comparison with the placebo ( 53.3 % ) and control ( 46.2 % , P<0.05 ) groups . Conclusions — Fifteen sessions of FES , applied to subjects with acute stroke plus st and ard rehabilitation , improved their motor and walking ability to the degree that more subjects were able to return to home Auricular acupuncture can be an effective treatment for acute anxiety , but there is a lack of direct comparisons of acupuncture to proven st and ard drug treatments . In this study we compared the efficacy of auricular acupuncture with intranasal midazolam , placebo acupuncture , and no treatment for reducing dental anxiety . Patients having dental extraction s ( n = 67 ) were r and omized to ( i ) auricular acupuncture , ( ii ) placebo acupuncture , and ( iii ) intranasal midazolam and compared with a no treatment group . Anxiety was assessed before the interventions , at 30 min , and after the dental extraction . Physiological variables were assessed continuously . With the no treatment group as control , the auricular acupuncture group , and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group ( Spielberger Stait-Trait Anxiety Inventory X1 , P = 0.012 and < 0.001 , respectively ) . In addition , patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed ( P = 0.032 and 0.049 , respectively ) . In conclusion , both , auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical Output:

Larger effects of placebo were also found in trials that did not inform patients about the possible placebo intervention . We did not find that placebo interventions have important clinical effects in general . However , in certain setting s placebo interventions can influence patient-reported outcomes , especially pain and nausea , though it is difficult to distinguish patient-reported effects of placebo from biased reporting .

MS2_1shot536

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To evaluate the effectiveness of community periodontal care intervention in type 2 diabetic patients with chronic periodontitis who participated in community non-communicable diseases management service . METHODS The r and omized controlled and blinded community trial with a duration of six months was design ed to compare effects of " periodontal initial therapy " on group I(22 cases ) , of " professional mechanical tooth cleaning ( PMTC ) , i.e. coronal scaling " on group II(19 cases ) and of " non- clinical therapy " on the control group(25 cases ) . The clinical periodontal indexes , such as probing depth ( PD ) , attachment loss ( AL ) , modified bleeding index ( mBI ) , plaque index ( PLI ) were obtained with a Williams type periodontal probe ; Laboratory examinations including glycosylated haemoglobin A1(HbA1C ) , glucose assay , were conducted . RESULTS The reductions of PD in groups I and II were 0.71 and 0.70 mm , respectively , which was more significant than in control group ( 0.20 mm ) ; the reductions of AL in groups I , II , and control group were 0.86 , 0.57 , and 0.03 mm , respectively , which showed significance in all the three groups . The subjects of groups I and II had 0.56 % and 1.01 % reductions of HbA1C respectively , and the significance was observed in group II . In addition , the improvement of HbA1C values in group II was highly correlated with the decrease in gingivitis ( r=0.51 , P=0.03 ) . CONCLUSION The community periodontal care approaches implemented in the community health service centers have significantly improved periodontal health as well as reduced glycemic level , which could be regarded as basic health care strategies for the patients with diabetes AIM The aim of this r and omized controlled clinical trial was to evaluate the clinical effects of chlorhexidine ( CHX ) application in a full-mouth disinfection ( FMD ) protocol in poorly controlled type-2 diabetic subjects with generalized chronic periodontitis . MATERIAL AND METHODS Thirty-eight subjects were r and omly assigned into FMD group ( n=19 ) : full-mouth scaling and root planing ( FMSRP ) within 24 h + local application of CHX gel + CHX rinses for 60 days or Control group ( n = 19 ) : FMSRP within 24 h + local application of placebo gel + placebo rinses for 60 days . Clinical parameters , glycated haemoglobin and fasting plasma glucose were assessed at baseline , 3 , 6 and 12 months post-therapies . RESULTS All clinical parameters improved significantly at 3 , 6 and 12 months post-therapies for both groups ( p < 0.05 ) . There were no significant differences between groups for any clinical parameters , and glycemic condition at any time-point ( p > 0.05 ) . CONCLUSIONS The treatments did not differ with respect to clinical parameters , including the primary outcome variable ( i.e. changes in clinical attachment level in deep pockets ) , for up to 12 months post-treatments Background 40 subjects with type 2 diabetes and moderate to severe CP were r and omly distributed to groups receiving either NSPT or OHI . Periodontal parameters , glycosylated haemoglobin ( HbA1c ) and high-sensitivity C-reactive protein ( hs-CRP ) were evaluated at baseline , 2- and 3-months intervals . Methods 40 subjects with type 2 diabetes and moderate to severe CP were r and omly distributed to groups receiving either NSPT or OHI . Periodontal parameters , glycosylated haemoglobin ( HbA1c ) and high-sensitivity C-reactive protein ( hs-CRP ) were evaluated at baseline , 2- and 3-months intervals . Results 15 subjects from NSPT group and 17 from OHI group completed the study . The difference in plaque index ( PI ) between NSPT and OHI groups were significant at 2 months recall ( p = 0.013 ) . There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters , HbA1c and CRP levels . At 3 months post-therapy , periodontal parameters improved significantly in both groups with sites with probing pocket depth ( PPD ) < 4 mm reported as 98 ± 1.8 % in NSPT group and 92 ± 14.9 % in OHI group . Mean PPD and mean probing attachment loss ( PAL ) within the NSPT group reduced significantly from baseline ( 2.56 ± 0.57 mm , 3.35 ± 0.83 mm ) to final visit ( 1.94 ± 0.26 mm , 2.92 ± 0.72 mm ) ( p = 0.003 , p < 0.001 ) . For OHI group , improvements in mean PPD and mean PAL were also seen from baseline ( 2.29 ± 0.69 mm , 2.79 ± 0.96 mm ) to final visit ( 2.09 ± 0.72 mm , 2.62 ± 0.97 mm ) ( p < 0.001 for both ) . Similarly , HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction ( p = 0.038 ) . Participants who demonstrated ≥ 50 % reduction in PPD showed significant reductions of HbA1c and hs-CRP levels ( p = 0.004 and p = 0.012 ) . Conclusion NSPT significantly reduced PI at 2 months post-therapy as compared to OHI . Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels . Trial registration Clinical Trials.gov : NCT01951547 BACKGROUND AND OBJECTIVE Several studies have shown that periodontitis can complicate the severity of diabetes by worsening the degree of glycemic control . The purpose of this study was to determine the effect of full-mouth tooth extraction on glycemic control among type 2 diabetic patients . MATERIAL AND METHODS A total of 58 patients with type 2 diabetes mellitus and advanced periodontitis who were requiring extraction of all remaining teeth were r and omized consecutively into treatment ( full-mouth tooth extraction ) and control groups ( no treatment ) . Eight patients were lost to follow-up or reported use of antibiotics , leaving 50 patients to be included in the analysis . All patients had all their remaining teeth in a hopeless condition . Relevant data were collected , and glycosylated hemoglobin ( HbA(1c ) ) and fasting blood glucose levels were measured at baseline and at follow-up times of 3 and 6 mo . RESULTS At baseline , the mean ( SD ) HbA(1c ) level was 8.6 % ( 1.24 ) in the treatment group and 7.7 % ( 0.87 ) in the control group . In the treatment group , the mean HbA(1c ) level decreased significantly from 8.6 % at baseline to 7.4 % after 3 mo of denture treatment , and continued to decrease to 7.3 % after 6 mo . In the control group , the mean HbA(1c ) decreased from 7.7 % at baseline to 7.5 % after 3 mo , and remained almost the same after 6 mo . After adjusting for the baseline HbA(1c ) , the mean reduction in HbA(1c ) after 3 mo in the treatment group [ 1.23 % ( 0.79 ) ] was significantly higher than the mean reduction in the control group [ 0.28 % ( 0.87 ) ] . CONCLUSION Full-mouth tooth extraction result ed in an improvement in glycemic control among diabetic patients . Large-scale multicentre clinical trials are needed to confirm the current evidence A controlled cross-sectional study with the aim of study ing oral health in patients with type 2 diabetes was carried out in a health care district in Sweden . The study included 102 r and omly sample d diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area , treated at the same Public Dental Service clinics . Oral conditions were measured at clinical and X-ray examinations . Diabetes-related variables were extracted from medical records . Diabetic patients suffered from xerostomia ( dry mouth ) to a significantly higher degree than non-diabetic controls did ( 53.5 vs. 28.4 % ; P=0.0003 ) . Sites with advanced periodontitis were more frequent in the diabetic group ( P=0.006 ) as were initial caries lesions ( P=0.02 ) . Diabetic subjects showed a greater need of periodontal treatment ( P=0.05 ) , caries prevention ( P=0.002 ) and prosthetic corrections ( P=0.004 ) . Diabetes duration or metabolic control of the disease was not related to periodontal status . However , patients with longer duration of diabetes had more manifest caries lesions ( P=0.05 ) as had those on insulin treatment when compared with patients on oral/diet or combined treatment ( P=0.0001 ) . The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health . Close collaboration between the patient , the primary health care and oral health professionals could be a way of improving the diabetic patient 's general and oral health The aim of this study was to evaluate changes in clinical parameters and levels of inflammatory biomarkers in plasma in periodontal patients with poorly controlled type 2 diabetes mellitus ( T2DM ) after non-surgical periodontal therapy . Twenty-eight poorly controlled T2DM patients were r and omly assigned to treatment with scaling and root planning ( SRP ) and SRP + subgingival minocycline administration . Clinical parameters , including the probing depth ( PD ) , bleeding on probing ( BOP ) , plaque score ( PS ) , clinical attachment level ( CAL ) , and plasma interleukin (IL)-6 , soluble receptor of advanced glycation end products ( sRAGE ) , chronic reactive protein ( CRP ) , and hemoglobin A1c ( HbA1c ) were measured before and after a 6-month treatment period . Significant changes in PD , BOP , PS , and CAL were found in both groups . The latent growth curve model showed an overall reduction in the log HbA1c level in the SRP group ( −0.082 , p = 0.033 ) . Small changes in the log sRAGE level and log CRP level in plasma were found in both groups . IL-6 in the plasma increased in the SRP group , but slightly decreased in the SRP+minocycline group ( 0.469 pg/ml , p = 0.172 ) . Non-surgical periodontal therapy with or without subgingival minocycline application may achieve significant periodontal improvement and moderate improvement in HbA1c , but had no significant effect on plasma levels of IL-6 , CRP , or sRAGE in patients with poorly controlled T2DM . For patients with both periodontal diseases and diabetes , non-surgical periodontal treatments may be helpful in their diabetic control OBJECTIVES We are conducting a clinical trial of the efficacy of periodontal therapy in the improvement of glycaemic control in veterans with poorly controlled diabetes . This report describes study design , recruitment and r and omization and compares baseline characteristics of the sample frame with those r and omized into study groups . METHODS Veterans with poorly controlled diabetes were r and omized in two groups : immediate periodontal therapy ( " early treatment " ) or usual care followed by periodontal therapy ( " deferred treatment " ) . Half of each group continued care for 12 months ; the other half returned to their usual care . We studied baseline patient characteristics , self-reported health measures , and clinical examination data . We examined means for continuous variables , frequencies for categorical variables and compared groups using t-tests and chi(2 ) tests ( alpha=0.05 for both ) . RESULTS The 193 r and omized participants were younger ( 58 years ) and had slightly higher HbA1c ( 10.2 % ) than the 2534 non-r and omized participants ( 64 years , HbA1c = 9.8 % ) . The deferred treatment group was more likely than the early treatment group to have a history of stroke , transient ischaemic attacks , and less likely to be current or former smokers . CONCLUSIONS The mechanism for r and omization was largely successful in this study IMPORTANCE Chronic periodontitis , a destructive inflammatory disorder of the supporting structures of the teeth , is prevalent in patients with diabetes . Limited evidence suggests that periodontal therapy may improve glycemic control . OBJECTIVE To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin ( HbA1c ) in persons with type 2 diabetes and moderate to advanced chronic periodontitis . DESIGN , SETTING , AND PARTICIPANTS The Diabetes and Periodontal Therapy Trial ( DPTT ) , a 6-month , single-masked , multicenter , r and omized clinical trial . Participants had type 2 diabetes , were taking stable doses of medications , had HbA1c levels between 7 % and less than 9 % , and untreated chronic periodontitis . Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers . INTERVENTIONS The treatment group ( n = 257 ) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months . The control Output:

Two broad comparisons were proposed:1 . periodontal therapy versus no active intervention/usual care;2 . The evidence was insufficient to conclude whether any of the treatments were associated with harm . Studies showed varying degrees of success with regards to achieving periodontal health , with some showing high levels of residual inflammation following treatment . Statistically significant improvements were shown for all periodontal indices ( BOP , CAL , GI , PI and PPD ) at 3 - 4 and 6 months in comparison 1 ; however , this was less clear for individual comparisons within the broad category of comparison 2 . There was no evidence to support that one periodontal therapy was more effective than another in improving glycaemic control in people with diabetes mellitus . In clinical practice , ongoing professional periodontal treatment will be required to maintain clinical improvements beyond 6 months . In addition , it will be important in future studies that the intervention is effective in reducing periodontal inflammation and maintaining it at lowered levels throughout the period of observation

MS2_1shot537

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background To strengthen suicide prevention skills in mental health care in The Netherl and s , multidisciplinary teams throughout the country are trained in the application of the new Dutch guideline on the assessment and treatment of suicidal behavior . Previous studies have shown beneficial effects of additional efforts for guideline implementation on professionals ’ attitude , knowledge , and skills . However , the effects on patients are equally important , but are rarely measured . The main objective of this study is to examine whether patients of multidisciplinary teams who are trained in guideline application show greater recovery from suicide ideation than patients of untrained teams . Methods / Design This is a multicentre cluster r and omized controlled trial ( RCT ) , in which multidisciplinary teams from mental health care institutions are matched in pairs , and r and omly allocated to either the experimental or control condition . In the experimental condition , next to the usual dissemination of the guideline ( internet , newsletter , books , publications , and congresses ) , teams will be trained in the application of the guideline via a 1-day small interactive group training program supported by e-learning modules . In the control condition , no additional actions next to usual dissemination of the guideline will be undertaken . Assessment s at patient level will start when the experimental teams are trained . Assessment s will take place upon admission and after 3 months , or earlier if the patient is discharged . The primary outcome is suicide ideation . Secondary outcomes are non-fatal suicide attempts , level of treatment satisfaction , and societal costs . Both a cost-effectiveness and cost-utility analysis will be performed . The effects of the intervention will be examined in multilevel models . Discussion The strengths of this study are the size of the study , RCT design , training of complete multidisciplinary teams , and the willingness of both management and staff to participate . Trial registration Netherl and s trial register : Background Interventions design ed to narrow the gap between research findings and clinical practice may be effective , but also costly . Economic evaluations are necessary to judge whether such interventions are worth the effort . We have evaluated the economic effects of a tailored intervention to support the implementation of guidelines for the use of antihypertensive and cholesterol-lowering drugs . The tailored intervention was evaluated in a r and omized trial , and was shown to significantly increase the use of thiazides for patients started on antihypertensive medication , but had little or no impact on other outcomes . The increased use of thiazides was not expected to have an impact on health outcomes . Methods and Findings We performed cost-minimization and cost-effectiveness analyses on data from a r and omized trial involving 146 general practice s from two geographical areas in Norway . Each practice was r and omized to either the tailored intervention ( 70 practice s ; 257 physicians ) or control group ( 69 practice s ; 244 physicians ) . Only patients that were being started on antihypertensive medication were included in the analyses . A multifaceted intervention was tailored to address identified barriers to change . Key components were an educational outreach visit with audit and feedback , and computerized reminders . Pharmacists conducted the visits . A cost-minimization framework was adopted , where the costs of intervention were set against the reduced treatment costs ( principally due to increased use of thiazides rather than more expensive medication ) . The cost-effectiveness of the intervention was estimated as the cost per additional patient being started on thiazides . The net annual cost ( cost minimization ) in our study population was US$ 53,395 , corresponding to US$ 763 per practice . The cost per additional patient started on thiazides ( cost-effectiveness ) was US$ 454 . The net annual savings in a national program was modeled to be US$ 761,998 , or US$ 540 per practice after 2 y. In this scenario the savings exceeded the costs in all but two of the sensitivity analyses we conducted , and the cost-effectiveness was estimated to be US$ 183 . Conclusions We found a significant shift in prescribing of antihypertensive drugs towards the use of thiazides in our trial . A major reason to promote the use of thiazides is their lower price compared to other drugs . The cost of the intervention was more than twice the savings within the time frame of our study . However , we predict modest savings over a 2-y period Abstract Objective : To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care . Design : A before and after pragmatic cluster r and omised controlled trial utilising a two by two incomplete block design . Setting : 60 general practice s in north east Engl and . Participants : General practitioners and practice nurses in the study practice s and their patients aged 18 or over with angina or asthma . Main outcome measures : Adherence to the guidelines , based on review of case notes and patient reported generic and condition specific outcome measures . Results : The computerised decision support system had no significant effect on consultation rates , process of care measures ( including prescribing ) , or any patient reported outcomes for either condition . Levels of use of the software were low . Conclusions : No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care . This was probably due to low levels of use of the software , despite the system being optimised as far as was technically possible . Even if the technical problems of producing a system that fully supports the management of chronic disease were solved , there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex , multiple conditions Background A r and omised trial of a multifaceted intervention for improving adherence to clinical practice guidelines for the pharmacological management of hypertension and hypercholesterolemia increased prescribing of thiazides , butdetected no impact onthe use of cardiovascular risk assessment toolsor achievement of treatment targets . We carried out a predominantly quantitative process evaluation to help explain and interpret the trial- findings . Methods Several data - sources were used including : question naires completed by pharmacists immediately after educational outreach visits , semi-structured interviews with physicians subjected to the intervention , and data extracted from their electronic medical records . Multivariate regression analyses were conducted to explore the association between possible explanatory variables and the observed variation across practice s for the three main outcomes . Results The attendance rate during the educational sessions in each practice was high ; few problems were reported , and the physicians were perceived as being largely supportive of the recommendations we promoted , except for some scepticism regarding the use of thiazides as first-line antihypertensive medication . Multivariate regression models could explain only a small part of the observed variation across practice s and across trial- outcomes , and key factors that might explain the observed variation in adherence to the recommendations across practice s were not identified . Conclusion This study did not provide compelling explanations for the trial results . Possible reasons for this include a lack of statistical power and failure to include potential explanatory variables in our analyses , particularly organisational factors . More use of qualitative research methods in the course of the trial could have improved our underst and ing BACKGROUND Good blood pressure ( BP ) control reduces the risk of complications in people with type 2 diabetes , yet many do not achieve this . Guidelines for managing hypertension recommend increasing antihypertensive medications until control is achieved , but the effect of such recommendations in routine primary care is unknown . AIM To evaluate the effectiveness of a BP treatment algorithm in primary care patients with type 2 diabetes . DESIGN OF STUDY A cluster r and omised controlled trial of 1534 patients with type 2 diabetes . SETTING Forty-two practice s in Nottingham , UK . METHOD Practice s were r and omised to continue usual care or to use a treatment algorithm design ed so that practice nurses and GPs would increase antihypertensive treatment in steps until the target of 140/80 mmHg was reached . Participants were assessed by a clinical interview and case note review at recruitment and at 1 year . The primary outcome measure was the proportion of participants achieving target BP at 1 year . RESULTS At 1 year there was no difference between the proportions of participants with well controlled BP in the intervention and control arms ( 36.6 % versus 34.3 % ; P = 0.27 ) . Mean systolic and diastolic blood pressures were identical in the two arms ( 143/78 mmHg ) . There was some evidence that participants in the intervention arm were more likely to be receiving higher doses of their antihypertensive drugs , although there was no significant difference in the number of different antihypertensive drugs prescribed . Participants in the intervention arm had a higher rate of primary care BP-related consultations over 12 months than those receiving usual care ( rate ratio = 1.55 , 95 % confidence interval [ CI ] = 1.26 to 1.88 , P<0.001 ) . CONCLUSION Despite increased monitoring and possibly higher doses of medication there was no improvement in blood pressure control . Improvements achieved by specialist nurse-led clinics in secondary care may not translate to people with type 2 diabetes in primary care setting Objectives : To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain . Design : A cluster r and omised controlled trial comparing an active strategy with st and ard dissemination . Setting : Primary care physiotherapy practice s. Participants : 113 physiotherapists were r and omly allocated to receive the guidelines by mail ( control group ) or to receive an additional active strategy ( intervention group ) which consisted of a multifaceted programme including education , discussion , role playing , feedback , and reminders . Main outcome measures : Adherence to the guidelines was measured by means of individual patients ’ forms recording the treatment completed by the physiotherapist . The forms were assessed using an algorithm based on the number of treatment sessions , treatment goals , interventions , and patient education . Results : Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain ( OR 2.39 ; 95 % CI 1.12 to 5.12 ) , more often set functional treatment goals ( OR 1.99 ; 95 % CI 1.06 to 3.72 ) , more often used mainly active interventions ( OR 2.79 ; 95 % CI 1.19 to 6.55 ) , and more often gave adequate patient education ( OR 3.59 ; 95 % CI 1.35 to 9.55 ) . They also adhered more to all four criteria ( OR 2.05 ; 95 % CI 1.15 to 3.65 ) . Conclusions : The active strategy moderately improved adherence to the guidelines . Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain Background Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice . Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience . The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting . Methods A pragmatic cluster r and omised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis . Hospitals were r and omised to one of three interventions : st and ard dissemination ( SD ) of a guideline package , SD plus a web-based re source championed by an opinion leader , and SD plus plan-do- study -act ( PDSA ) . The primary outcome was duration of fluid fast prior to induction of anaesthesia . Secondary outcomes included duration of food fast , patients ’ experiences , and stakeholders ’ experiences of implementation , including influences . ANOVA was used to test differences over time and interventions . Results Nineteen acute NHS hospitals participated . Across timepoints , 3,505 duration of fasting observations were recorded . No significant effect of the interventions was observed for either fluid or food fasting times . The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone . The process evaluation showed different types of impact , including changes to practice s , policies , and attitudes . A rich picture of the implementation challenges emerged , including inter-professional tensions and a lack of clarity for decision-making authority and responsibility . Conclusions This was a large , complex study and one of the first national r and omised controlled trials conducted within acute care in implementation research . The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple ; however , implementation and practical challenges influenced the interventions ’ impact . A set of conditions for implementation emerges from the findings of this study , which are presented as theoretically transferable propositions that have international relevance .Trial registration IS RCT N18046709 - Peri-operative Implementation Study Evaluation ( POISE ) Abstract Objective To test a multifaceted collaborative quality improvement intervention design ed to promote evidence based surfactant treatment for preterm infants of 23 - 29 weeks ' gestation . Design Cluster r and omised controlled trial Setting and participants 114 neonatal intensive care units ( which treated 6039 infants of 23 - 29 weeks gestation born in 2001 ) . Main outcome measures Process of care measures : proportion of infants receiving first surfactant in the delivery room , proportion receiving first surfactant more than two hours after birth , and median time from birth to first dose of surfactant . Clinical outcomes : death before discharge home , and pneumothorax . Intervention Multifaceted collaborative quality improvement advice including audit and feedback , evidence review s , an interactive training workshop , and ongoing faculty support via conference calls and email . Results Compared with those in control hospitals , infants in intervention hospitals were more likely to receive surfactant in the delivery room ( adjusted odds ratio 5.38 ( 95 % confidence interval 2.84 to 10.20 ) ) , were less likely to receive the first do Output:

Providing healthcare professionals with a tool to improve implementation of a guideline may lead to little or no difference in costs to the health service . Implementation tools developed by recognised guideline producers probably lead to improved healthcare professionals ' adherence to guidelines in the management of non-specific low back pain and ordering thyroid-function tests . There are limited data on the relative costs of implementing these interventions .There are no studies evaluating the effectiveness of interventions targeting the organisation of care ( e.g. benchmarking tools , costing templates , etc . We could not draw any conclusions about our second objective , the comparative effectiveness of implementation tools , due to the small number of studies , the heterogeneity between interventions , and the clinical conditions that were targeted

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Various studies find relationships among anxiety and depressive disorders of adolescence and adulthood . This study prospect ively examines the magnitude of longitudinal associations between adolescent and adult anxiety or depressive disorders . METHODS An epidemiologically selected sample of 776 young people living in upstate New York received DSM-based psychiatric assessment s in 1983 , 1985 , and 1992 using structured interviews . The magnitude of the association between adolescent and adult anxiety or depressive disorders was quantified using odds ratios generated from logistic regression analyses and from a set of latent Markov analyses . We focus on longitudinal associations among narrowly defined DSM anxiety or depressive disorders . RESULTS In simple logistic models , adolescent anxiety or depressive disorders predicted an approximate 2- to 3-fold increased risk for adulthood anxiety or depressive disorders . There was evidence of specificity in the course of simple and social phobia but less specificity in the course of other disorders . Results from the analyses using latent variables suggested that while most adolescent disorders were no longer present in young adulthood , most adult disorders were preceded by adolescent disorders . CONCLUSIONS An anxiety or depressive disorder during adolescence confers a strong risk for recurrent anxiety or depressive disorders during early adulthood . Most anxiety and depressive disorders in young adults may be preceded by anxiety or depression in adolescence OBJECTIVE The goal of this study was to examine the associations between specific anxiety disorders and the risk of major depressive disorder and to explore the role of various clinical characteristics of anxiety disorders in these relationships using a prospect i ve , longitudinal design . METHOD The data are from a 4-year prospect i ve , longitudinal community study , which included both baseline and follow-up survey data on 2548 adolescents and young adults aged 14 to 24 years at baseline . DSM-IV diagnoses were made using the Munich-Composite International Diagnostic Interview . RESULTS The presence at baseline of any anxiety disorder ( odds ratio [ OR ] = 2.2 [ 95 % CI = 1.6 to 3.2 ] ) and each of the anxiety disorders ( specific phobia , OR = 1.9 [ 95 % CI = 1.3 to 2.8 ] ; social phobia , OR = 2.9 [ 95 % CI = 1.7 to 4.8 ] ; agoraphobia , OR = 3.1 [ 95 % CI = 1.4 to 6.7 ] ; panic disorder , OR = 3.4 [ 95 % CI = 1.2 to 9.0 ] ; generalized anxiety disorder , OR = 4.5 [ 95 % CI = 1.9 to 10.3 ] ) was associated with a significantly ( p < .05 ) increased risk of first onset of major depressive disorder . These associations remained significant after we adjusted for mental disorders occurring prior to the onset of the anxiety disorder , with the exception of the panic disorder association . The following clinical characteristics of anxiety disorders were associated with a significantly ( p < .05 ) increased risk of developing major depressive disorder : more than 1 anxiety disorder , severe impairment due to the anxiety disorder , and comorbid panic attacks . In the final model , which included all clinical characteristics , severe impairment remained the only clinical characteristic that was an independent predictor of the development of major depressive disorder ( OR = 2.2 [ 95 % CI = 1.0 to 4.4 ] ) . CONCLUSION Our findings suggest that anxiety disorders are risk factors for the first onset of major depressive disorder . Although a number of clinical characteristics of anxiety disorders appear to play a role in the association between anxiety disorders and depression , severe impairment is the strongest predictor of major depressive disorder OBJECTIVE This study evaluated follow-up outcomes associated with cognitive behavioral therapy ( CBT ) for childhood anxiety by comparing successfully and unsuccessfully treated participants 6.72 to 19.17 years after treatment . METHOD Participants were a sample of 66 youths ( ages 7 - 14 years at time of treatment , ages 18 - 32 years at present follow-up ) who had been diagnosed with an anxiety disorder and r and omized to treatment in a r and omized clinical trial on average 16.24 ( SD = 3.56 , range = 6.72 - 19.17 ) years prior . The present follow-up included self-report measures and a diagnostic interview to assess anxiety , depression , and substance misuse . RESULTS Compared with those who responded successfully to CBT for an anxiety disorder in childhood , those who were less responsive had higher rates of panic disorder , alcohol dependence , and drug abuse in adulthood . Relative to a normative comparison group , those who were less responsive to CBT in childhood had higher rates of several anxiety disorders and substance misuse problems in adulthood . Participants remained at particularly increased risk , relative to the normative group , for generalized anxiety disorder and nicotine dependence regardless of initial treatment outcome . CONCLUSIONS The present study is the first to assess the long-term follow-up effects of CBT treatment for an anxiety disorder in youth on anxiety , depression , and substance abuse through the period of young adulthood when these disorders are often seen . Results support the presence of important long-term benefits of successful early CBT for anxiety OBJECTIVE We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study ( CAMS ) . METHOD CAMS youth ( N = 488 ; 74 % ≤ 12 years of age ) with DSM-IV separation , generalized , or social anxiety disorder were r and omized to 12 weeks of cognitive-behavioral therapy ( CBT ) , sertraline ( SRT ) , CBT+SRT ( COMB ) , or medication management/pill placebo ( PBO ) . Responders attended 6 monthly booster sessions in their assigned treatment arm ; youth in COMB and SRT continued on their medication throughout this period . Efficacy of COMB , SRT , and CBT ( n = 412 ) was assessed at 24 and 36 weeks postr and omization . Youth r and omized to PBO ( n = 76 ) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here . Independent evaluators blind to study condition assessed anxiety severity , functioning , and treatment response . Concomitant treatments were allowed but monitored over follow-up . RESULTS The majority ( > 80 % ) of acute responders maintained positive response at both weeks 24 and 36 . Consistent with acute outcomes , COMB maintained advantage over CBT and SRT , which did not differ , on dimensional outcomes ; the 3 treatments did not differ on most categorical outcomes over follow-up . Compared to COMB and CBT , youth in SRT obtained more concomitant psychosocial treatments , whereas those in SRT and CBT obtained more concomitant combined ( medication plus psychosocial ) treatment . CONCLUSIONS COMB maintained advantage over CBT and SRT on some measures over follow-up , whereas the 2 monotherapies remained indistinguishable . The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies , although other explanations are possible . Although outcomes were variable , most CAMS-treated youth experienced sustained treatment benefit . Clinical trial registration information-Child and Adolescent Anxiety Disorders ( CAMS ) ; URL : http:// clinical trials.gov . Unique identifier : NCT00052078 BACKGROUND Anxiety disorders are common psychiatric conditions affecting children and adolescents . Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders , little is known about their relative or combined efficacy . METHODS In this r and omized , controlled trial , we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder , generalized anxiety disorder , or social phobia to receive 14 sessions of cognitive behavioral therapy , sertraline ( at a dose of up to 200 mg per day ) , a combination of sertraline and cognitive behavioral therapy , or a placebo drug for 12 weeks in a 2:2:2:1 ratio . We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4 , 8 , and 12 . RESULTS The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7 % for combination therapy ( P<0.001 ) , 59.7 % for cognitive behavioral therapy ( P<0.001 ) , and 54.9 % for sertraline ( P<0.001 ) ; all therapies were superior to placebo ( 23.7 % ) . Combination therapy was superior to both monotherapies ( P<0.001 ) . Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response ; combination therapy had a greater response than cognitive behavioral therapy , which was equivalent to sertraline , and all therapies were superior to placebo . Adverse events , including suicidal and homicidal ideation , were no more frequent in the sertraline group than in the placebo group . No child attempted suicide . There was less insomnia , fatigue , sedation , and restlessness associated with cognitive behavioral therapy than with sertraline . CONCLUSIONS Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders ; a combination of the two therapies had a superior response rate . ( Clinical Trials.gov number , NCT00052078 . BACKGROUND If most adults with mental disorders are found to have a juvenile psychiatric history , this would shift etiologic research and prevention policy to focus more on childhood mental disorders . METHOD Our prospect i ve longitudinal study followed up a representative birth cohort ( N = 1037 ) . We made psychiatric diagnoses according to DSM criteria at 11 , 13 , 15 , 18 , 21 , and 26 years of age . Adult disorders were defined in the following 3 ways : ( 1 ) cases diagnosed using a st and ardized diagnostic interview , ( 2 ) the subset using treatment , and ( 3 ) the subset receiving intensive mental health services . Follow-back analyses ascertained the proportion of adult cases who had juvenile diagnoses and the types of juvenile diagnoses they had . RESULTS Among adult cases defined via the Diagnostic Interview Schedule , 73.9 % had received a diagnosis before 18 years of age and 50.0 % before 15 years of age . Among treatment-using cases , 76.5 % received a diagnosis before 18 years of age and 57.5 % before 15 years of age . Among cases receiving intensive mental health services , 77.9 % received a diagnosis before 18 years of age and 60.3 % before 15 years of age . Adult disorders were generally preceded by their juvenile counterparts ( eg , adult anxiety was preceded by juvenile anxiety ) , but also by different disorders . Specifically , adult anxiety and schizophreniform disorders were preceded by a broad array of juvenile disorders . For all adult disorders , 25 % to 60 % of cases had a history of conduct and /or oppositional defiant disorder . CONCLUSIONS Most adult disorders should be reframed as extensions of juvenile disorders . In particular , juvenile conduct disorder is a priority prevention target for reducing psychiatric disorder in the adult population Output:

CBT effects compared to active controls were mixed ( EQ1 ) . SSRI/SNRI were more effective than placebo ( EQ1 ) but comparative effectiveness remains uncertain . RCTs of web/computer-based interventions showed mixed results ( EQ1 ) . CBM/ABM was not more efficacious than active controls ( EQ1 ) . High quality RCTs support treatment with CBT and medication .

MS2_1shot539

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Introduction Physicians dedicate substantial time to documentation . Scribes are sometimes used to improve efficiency by performing documentation tasks , although their impacts have not been prospect ively evaluated . Our objective was to assess a scribe program ’s impact on emergency department ( ED ) throughput , physician time utilization , and job satisfaction in a large academic emergency medicine practice . Methods We evaluated the intervention using pre- and post-intervention surveys and administrative data . All site physicians were included . Pre- and post-intervention data were collected in four-month periods one year apart . Primary outcomes included changes in monthly average ED length of stay ( LOS ) , provider-specific average relative value units ( RVUs ) per hour ( raw and normalized to volume ) , self-reported estimates of time spent teaching , self-reported estimates of time spent documenting , and job satisfaction . We analyzed data using descriptive statistics and appropriate tests for paired pre-post differences in continuous , categorical , and ranked variables . Results Pre- and post-survey response rates were 76.1 % and 69.0 % , respectively . Most responded positively to the intervention , although 9.5 % reported negative impressions . There was a 36 % reduction ( 25%–50 % ; p<0.01 ) in time spent documenting and a 30 % increase ( 11%–46 % , p<0.01 ) in time spent in direct patient contact . No statistically significant changes were seen in job satisfaction or perception of time spent teaching . ED volume increased by 88 patients per day ( 32–146 , p=0.04 ) pre- to post- and LOS was unchanged ; rates of patients leaving against medical advice dropped , and rates of patients leaving without being seen increased . RVUs per hour increased 5.5 % and per patient 5.3 % ; both were statistically significant . No statistically significant changes were seen in patients seen per hour . There was moderate correlation between changes in ED volume and changes in productivity metrics . Conclusion Scribes were well received in our practice . Documentation time was substantially reduced and redirected primarily to patient care . Despite an ED volume increase , LOS was maintained , with fewer patients leaving against medical advice but more leaving without being seen . RVUs per hour and per patient both increased PURPOSE Scribes are increasingly being used in clinical practice despite a lack of high- quality evidence regarding their effects . Our objective was to evaluate the effect of medical scribes on physician satisfaction , patient satisfaction , and charting efficiency . METHODS We conducted a r and omized controlled trial in which physicians in an academic family medicine clinic were r and omized to 1 week with a scribe then 1 week without a scribe for the course of 1 year . Scribes drafted all relevant documentation , which was review ed by the physician before attestation and signing . In encounters without a scribe , the physician performed all charting duties . Our outcomes were physician satisfaction , measured by a 5-item instrument that included physicians ’ perceptions of chart quality and chart accuracy ; patient satisfaction , measured by a 6-item instrument ; and charting efficiency , measured by time to chart close . RESULTS Scribes improved all aspects of physician satisfaction , including overall satisfaction with clinic ( OR = 10.75 ) , having enough face time with patients ( OR = 3.71 ) , time spent charting ( OR = 86.09 ) , chart quality ( OR = 7.25 ) , and chart accuracy ( OR = 4.61 ) ( all P values < .001 ) . Scribes had no effect on patient satisfaction . Scribes increased the proportion of charts that were closed within 48 hours ( OR = 1.18 , P = .028 ) . CONCLUSIONS To our knowledge , we have conducted the first r and omized controlled trial of scribes . We found that scribes produced significant improvements in overall physician satisfaction , satisfaction with chart quality and accuracy , and charting efficiency without detracting from patient satisfaction . Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout PURPOSE The increasing use of electronic medical records during the clinical encounter brings not only benefits but also barriers that may affect the doctor-patient relationship and increase the work burden of the physician . We evaluated whether the use of an electronic medical record scribe in an academic urology program would ameliorate these problems . MATERIAL S AND METHODS We r and omly assigned electronic medical record scribes to the office hours of 5 academic urologists , and using surveys we evaluated patient and physician acceptance and satisfaction . RESULTS Patients were accepting of an electronic medical record scribe and satisfaction rates were high ( 93 % vs 87 % in the absence of a scribe , p = 0.36 ) . Patients were comfortable disclosing urological information in the presence of the scribe . Physicians were dramatically more satisfied with office hours when a scribe was present ( 69 % vs 19 % , p < 0.001 ) . We were unable to determine whether the presence of a scribe improves productivity . CONCLUSIONS Electronic medical record scribes in a urology practice may be a practical solution to provide documentation while maintaining or improving the doctor-patient relationship because they increase physician satisfaction and do not detract from patient satisfaction Background Use of electronic health records ( EHRs ) is associated with physician stress and burnout . While emergency departments and subspecialists have used scribes to address this issue , little is known about the impact of scribes in academic primary care . Objective Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine ( GIM ) clinic . Design Prospect i ve , pre-post-pilot study . During the 3-month pilot , physicians had clinic sessions with and without a scribe . We assessed changes in ( 1 ) physician workplace satisfaction and burnout , ( 2 ) time spent on EHR documentation , and ( 3 ) patient satisfaction . Participants Six GIM faculty and a convenience sample of their patients ( N = 325 ) at an academic GIM clinic . Main Measures A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout . Physicians used logs to record time spent on EHR documentation outside of clinic hours . A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe . Key Results Of six physicians , 100 % were satisfied with clinic workflow post-pilot ( vs. 33 % pre-pilot ) , and 83 % were satisfied with EHR use post-pilot ( vs. 17 % pre-pilot ) . Physician burnout was low at baseline and did not change post-pilot . Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session ( p = 0.02 ) . Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age , gender , and race . Compared to patients 65 years or older , younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present ( p = 0.03 and 0.02 , respectively ) . Male patients were more likely to report that they disliked having a scribe ( p = 0.03 ) . Conclusion In an academic GIM setting , employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction Objective Scribes have been used in the emergency department to improve physician productivity and patient interaction . There are no controlled , prospect i ve studies of scribe use in the clinic setting . Methods A prospect i ve controlled study compared st and ard visits ( 20 minute follow-up and 40 minute new patient ) to a scribe system ( 15 minute follow-up and 30 minute new patient ) in a cardiology clinic . Physician productivity , patient satisfaction , physician – patient interaction , and revenue were measured . Results Four physicians saw 129 patients using st and ard care and 210 patients with scribes during 65 clinic hours each . Patients seen per hour increased ( P < 0.001 ) from 2.2 ± 0.3 to 3.5 ± 0.4 ( 59 % increase ) and work relative value units ( wRVU ) per hour increased ( P < 0.001 ) from 3.5 ± 1.3 to 5.5 ± 1.3 ( 57 % increase ) . Patient satisfaction was high at baseline and unchanged with scribes . In a sub study , direct patient contact time was lower ( 9.1 ± 2.0 versus 12.9 ± 3.4 minutes ; P < 0.01 ) for scribe visits , but time of patient interaction ( without computer ) was greater ( 6.7 ± 2.1 versus 1.5 ± 1.9 minutes ; P < 0.01 ) . Subjective assessment of physician – patient interaction ( 1–10 ) was higher ( P < 0.01 ) on scribe visits ( 9.1 ± 0.9 versus 7.9 ± 1.1 ) . Direct and indirect ( downstream ) revenue per patient seen was $ 142 and $ 2,398 , with $ 205,740 additional revenue generated from the 81 additional patients seen with scribes . Conclusion Using scribes in a cardiology clinic is feasible , produces improvements in physician – patient interaction , and results in large increases in physician productivity and system cardiovascular revenue BACKGROUND Scribes are unlicensed professionals trained in medical data entry . Limited data exist on the impact of scribes on provider time management in the emergency department ( ED ) . Time-motion analysis is a tool utilized in business to capture detailed movements and duration s to task completion . It offers a means to categorize how providers allocate their time during a clinical shift . OBJECTIVE Evaluate the impact of scribes on how ED providers spend their time . METHODS A prospect i ve observational study was conducted to assess scribe impact on provider time utilization . Four research assistants ( RAs ) observed attending providers on 24 8-h control shifts ( without a scribe ) , and 24 scribed shifts . RAs observed and categorized provider activity . Providers self-reported after-hours documentation times . Two- sample t-tests were used for normally distributed data , and Wilcoxon rank-sum tests were used for skewed data . All tests were two-sided , and p-values < 0.05 were considered statistically significant . RESULTS Scribes decreased total documentation time both on shift ( mean 55.3 vs. 36.4 min , p < 0.001 ) and post shift ( mean 42.5 vs. 23.3 min , p = 0.038 ) . They did not significantly decrease the amount of time spent review ing the medical records or placing orders , nor did they have an impact on provider time spent at patients ' bedside or time spent discussing patient care with team members . CONCLUSION The presence of scribes decreased provider documentation time but did not change the amount of time spent at the bedside or communicating with other team members . Scribes may be a potential strategy to decrease the clerical burden BACKGROUND Medical scribes are frequently incorporated into the patient care model to improve provider efficiency and enable providers to refocus their attention to the patient rather than the electronic health record ( EHR ) . The medical scribe program was based on four pillars ( objectives ): ( 1 ) provider satisfaction , ( 2 ) st and ardized documentation , ( 3 ) documentation components for risk adjustment , and ( 4 ) revenue enhancement . METHODS The medical scribe program was deployed in nine non-resident-supported clinics ( internal medicine , ophthalmology , orthopedics , hematology/oncology , urology ) , with the medical scribes ( who have no clinical duties ) supporting both physicians and advanced practice providers ( nurse practitioners and physician assistants ) . This paper describes a prospect i ve quasi-experimental study conducted at an academic , inner-city , hospital-based clinic system , RESULTS : A pre-post analysis showed positive results ; of the 51 providers , 44 responded to the survey pre and 41 responded post . Respondents in the post-scribe group felt that a scribe was valuable ( 90.2 % ) , that documentation time at the office improved ( 75.0 % poor or marginal pre-scribe , vs. 24 % post ; p < 0.0001 ) , and that time spent on the EHR at home declined ( 63.6 % with excessive or moderately high home EHR time pre vs. 31.7 % post ; p = 0.003 ) . More providers felt satisfied with their role in clinic with the use of scribes , and more providers felt that with scribes they could listen sufficiently to patients ( p < 0.05 ) . CONCLUSION Scribe support was well received across the institution in multiple clinical setting s. Benefits for providers were seen in documentation time and ability to listen to patients . Scribes appear to be an effective intervention for improving clinician work life Background : Medical scribes are a clinical innovation increasingly being used in primary care . The impact of scribes in primary care remain unclear . We aim ed to examine the impact of medical scribes on productivity , time spent facing the patient during the visit , and patient comfort with scribes in primary care . Methods : We conducted a prospect i ve observational pre-post study of 5 family and internal medicine-pediatrics physicians and their patients at an urban safety net health clinic . Medical scribes accompanied providers in the examination room and documented the clinical encounter . After an initial phase-in period , we added an additional 20-minute patient slot per 200-minute session . We examined productivity by using electronic medical record data on the number of patients seen and work relative value units ( work RVUs ) per hour . We directly observed clinical encounters to measure the amount of time providers spent facing patients and other visit components . We queried patient comfort with scribes by using surveys administered after the visit . Results : Work RVUs per hour increased by 10.5 % from 2.59 prescribe to 2.86 post-scribe ( P < .001 ) . Patients seen per hour increased by 8.8 % from 1.82 to 1.98 ( P < .001 ) . Work RVUs per patient did not change . After scribe implementation , time spent facing the patient increased by 57 % ( P < .0 Output:

We found that there is significant variation in scribe expectations and responsibilities across healthcare organizations ; scribes also frequently adapt their work based on the provider 's style and preferences . Further , scribes ' job extends far beyond capturing conversation in the exam room ; they also actively interact with patients and the care team and integrate data from other sources such as prior charts and lab test results . First , a one-size-fits-all solution will be unlikely to work because of the significant variation in scribe work . Finally , issues of patient consent and privacy have yet to be adequately addressed , which could become paramount barriers to implementing such technologies in realistic clinical setting s. CONCLUSIONS Medical scribes perform complex and delicate work .

MS2_1shot540

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Adjustment for prognostic covariates can lead to increased power in the analysis of r and omized trials . However , adjusted analyses are not often performed in practice . Methods We used simulation to examine the impact of covariate adjustment on 12 outcomes from 8 studies across a range of therapeutic areas . We assessed ( 1 ) how large an increase in power can be expected in practice ; and ( 2 ) the impact of adjustment for covariates that are not prognostic . Results Adjustment for known prognostic covariates led to large increases in power for most outcomes . When power was set to 80 % based on an unadjusted analysis , covariate adjustment led to a median increase in power to 92.6 % across the 12 outcomes ( range 80.6 to 99.4 % ) . Power was increased to over 85 % for 8 of 12 outcomes , and to over 95 % for 5 of 12 outcomes . Conversely , the largest decrease in power from adjustment for covariates that were not prognostic was from 80 % to 78.5 % . Conclusions Adjustment for known prognostic covariates can lead to substantial increases in power , and should be routinely incorporated into the analysis of r and omized trials . The potential benefits of adjusting for a small number of possibly prognostic covariates in trials with moderate or large sample sizes far outweigh the risks of doing so , and so should also be considered Background Intermittent preventive treatment in pregnancy has not been evaluated outside of Africa . Low birthweight ( LBW , < 2,500 g ) is common in Papua New Guinea ( PNG ) and contributing factors include malaria and reproductive tract infections . Methods From November 2009 to February 2013 , we conducted a parallel group , r and omised controlled trial in pregnant women ( ≤26 gestational weeks ) in PNG . Sulphadoxine-pyrimethamine ( 1,500/75 mg ) plus azithromycin ( 1 g twice daily for 2 days ) ( SPAZ ) monthly from second trimester ( intervention ) was compared against sulphadoxine-pyrimethamine and chloroquine ( 450 to 600 mg , daily for three days ) ( SPCQ ) given once , followed by SPCQ placebo ( control ) . Women were assigned to treatment ( 1:1 ) using a r and omisation sequence with block sizes of 32 . Participants were blinded to assignments . The primary outcome was LBW . Analysis was by intention-to-treat . Results Of 2,793 women r and omised , 2,021 ( 72.4 % ) were included in the primary outcome analysis ( SPCQ : 1,008 ; SPAZ : 1,013 ) . The prevalence of LBW was 15.1 % ( 305/2,021 ) . SPAZ reduced LBW ( risk ratio [ RR ] : 0.74 , 95 % CI : 0.60–0.91 , P = 0.005 ; absolute risk reduction ( ARR ) : 4.5 % , 95 % CI : 1.4–7.6 ; number needed to treat : 22 ) , and preterm delivery ( 0.62 , 95 % CI : 0.43–0.89 , P = 0.010 ) , and increased mean birthweight ( 41.9 g , 95 % CI : 0.2–83.6 , P = 0.049 ) . SPAZ reduced maternal parasitaemia ( RR : 0.57 , 95 % CI : 0.35–0.95 , P = 0.029 ) and active placental malaria ( 0.68 , 95 % CI : 0.47–0.98 , P = 0.037 ) , and reduced carriage of gonorrhoea ( 0.66 , 95 % CI : 0.44–0.99 , P = 0.041 ) at second visit . There were no treatment-related serious adverse events ( SAEs ) , and the number of SAEs ( intervention 13.1 % [ 181/1,378 ] , control 12.7 % [ 174/1,374 ] , P = 0.712 ) and AEs ( intervention 10.5 % [ 144/1,378 ] , control 10.8 % [ 149/1,374 ] , P = 0.737 ) was similar . A major limitation of the study was the high loss to follow-up for birthweight . Conclusions SPAZ was efficacious and safe in reducing LBW , possibly acting through multiple mechanisms including the effect on malaria and on sexually transmitted infections . The efficacy of SPAZ in the presence of resistant parasites and the contribution of AZ to bacterial antibiotic resistance require further study . The ability of SPAZ to improve pregnancy outcomes warrants further evaluation . Trial registration Clinical Trials.gov NCT01136850 ( 06 April 2010 ) Background Intermittent preventive treatment with sulphadoxine-pyrimethamine ( IPTp-SP ) is being implemented in most malaria endemic countries as a st and ard two-doses regimen as it reduces the risk of low birth weight ( LBW ) and the prevalence of maternal anaemia . Nevertheless , where the risk of infection close to delivery is high because of intense transmission , a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome . Methods Pregnant women in the 2nd or 3rd trimester were r and omized to receive either 2 ( SP2 ) or 3 doses ( SP3 ) of SP . Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule . Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed . The prevalence of LBW ( < 2500 g ) , severe anaemia ( Hb < 8 g/dL ) and premature birth was analysed using intention-to-treat ( ITT ) and per- protocol ( PP ) analysis . Results Data from 1274 singleton pregnancies were analysed ( 641 in the SP3 and 633 in the SP2 group ) . The uptake of the intervention appeared to be low . Though the prevalence of LBW in both intervention groups was similar ( adjusted Incident Rate Ratio , AIRR = 0.92 , 95%CI : 0.69 - 1.24 ) in the ITT analysis , the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group ( AIRR = 0.38 , 95%CI : 0.16 - 0.90 ) . The PP analysis showed a trend of reduced risk of LBW , severe anaemia and premature delivery in the SP3 group , albeit the difference between two and three IPTp-SP did not reach statistical significance . Conclusion The risk of LBW and severe anaemia tended to be lower in the SP3 group , though this was not statistically significant , probably due to the low uptake of the intervention which reduced the power of the study . Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in setting s where transmission is markedly seasonal Background Daily trimethoprim-sulfamethoxazole ( TMP-SMX ) and insecticide-treated nets remain the main interventions for prevention of malaria in human immunodeficiency virus (HIV)-infected pregnant women in Africa . However , antifolate and pyrethroid resistance threaten the effectiveness of these interventions , and new ones are needed . Methods We conducted a double-blinded , r and omized , placebo-controlled trial comparing daily TMP-SMX plus monthly dihydroartemisinin-piperaquine ( DP ) to daily TMP-SMX alone in HIV-infected pregnant women in an area of Ug and a where indoor residual spraying of insecticide had recently been implemented . Participants were enrolled between gestation weeks 12 and 28 and given an insecticide-treated net . The primary outcome was detection of active or past placental malarial infection by histopathologic analysis . Secondary outcomes included incidence of malaria , parasite prevalence , and adverse birth outcomes . Result All 200 women enrolled were followed through delivery , and the primary outcome was assessed in 194 . There was no statistically significant difference in the risk of histopathologically detected placental malarial infection between the daily TMP-SMX plus DP arm and the daily TMP-SMX alone arm ( 6.1 % vs. 3.1 % ; relative risk , 1.96 ; 95 % confidence interval , .50 - 7.61 ; P = .50 ) . Similarly , there were no differences in secondary outcomes . Conclusions Among HIV-infected pregnant women in the setting of indoor residual spraying of insecticide , adding monthly DP to daily TMP-SMX did not reduce the risk of placental or maternal malaria or improve birth outcomes . Clinical Trials Registration NCT02282293 BACKGROUND In 2003 , Mali introduced intermittent preventive therapy in pregnancy ( ITPp ) with sulfadoxine-pyrimethamine ( SP ) for the control of malaria in pregnancy , consisting of 2 doses of SP given in the 2nd and 3rd trimester . This widely used regimen , although very effective , leaves many women unprotected from malaria during the last 4-to-8 weeks of gestation , which is a pivotal period for fetal weight gain . The aim of the study was to compare the efficacy and safety of 3-dose versus 2-dose IPTp-SP for the prevention of placental malaria and associated low birth weight ( LBW ) . METHODS We conducted a parallel-group , open-label , individually r and omized controlled superiority trial involving 814 women of all gravidity , enrolled from April 2006 through March 2008 . All women were seen at least 3 times and received either 2 ( n = 401 ) or 3 ( n = 413 ) doses of IPTp-SP . The primary endpoint measured was placental malaria , LBW , preterm births , and maternal anemia were secondary endpoints , and severe maternal skin reactions and neonatal jaundice were safety endpoints . RESULTS Among the 96 % of study subjects who were followed up until delivery , the prevalence of placental malaria was 2-fold lower in the 3-dose group ( 8.0 % ) than in the 2-dose group ( 16.7 % ) ; the adjusted prevalence ratio ( APR ) was 0.48 ( 95 % confidence interval [ CI ] , 0.32 - 0.71 ) . LBW and preterm births were also reduced ; the prevalence of LBW was 6.6 % in the 3-dose group versus 13.3 % in the 2-dose group ( APR , 0.50 ; 95 % CI , 0.32 - 0.79 ) , and the prevalence of preterm births was 3.2 % versus 8.9 % ( APR , 0.37 ; 95 % CI , 0.19 - 0.71 ) . No significant reductions in maternal anemia or differences in safety endpoints were observed . CONCLUSIONS Adding a third dose of ITPp-SP halved the risk of placental malaria , LBW , and preterm births in all gravidae , compared with the st and ard 2-dose regimen , in this area of highly seasonal transmission with low levels of SP resistance . CLINICAL TRIALS REGISTRATION IS RCT N 74189211 BACKGROUND Intermittent treatment with sulfadoxine-pyrimethamine is widely recommended for the prevention of malaria in pregnant women in Africa . However , with the spread of resistance to sulfadoxine-pyrimethamine , new interventions are needed . METHODS We conducted a double-blind , r and omized , controlled trial involving 300 human immunodeficiency virus (HIV)-uninfected pregnant adolescents or women in Ug and a , where sulfadoxine-pyrimethamine resistance is widespread . We r and omly assigned participants to a sulfadoxine-pyrimethamine regimen ( 106 participants ) , a three-dose dihydroartemisinin-piperaquine regimen ( 94 participants ) , or a monthly dihydroartemisinin-piperaquine regimen ( 100 participants ) . The primary outcome was the prevalence of histopathologically confirmed placental malaria . RESULTS The prevalence of histopathologically confirmed placental malaria was significantly higher in the sulfadoxine-pyrimethamine group ( 50.0 % ) than in the three-dose dihydroartemisinin-piperaquine group ( 34.1 % , P=0.03 ) or the monthly dihydroartemisinin-piperaquine group ( 27.1 % , P=0.001 ) . The prevalence of a composite adverse birth outcome was lower in the monthly dihydroartemisinin-piperaquine group ( 9.2 % ) than in the sulfadoxine-pyrimethamine group ( 18.6 % , P=0.05 ) or the three-dose dihydroartemisinin-piperaquine group ( 21.3 % , P=0.02 ) . During pregnancy , the incidence of symptomatic malaria was significantly Output:

The review demonstrated that statistical analysis of safety data in anti-malarial drugs for malarial chemoprevention in pregnancy RCTs is inadequate .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Hermassi , S , Chelly , MS , Fathloun , M , and Shephard , RJ . The effect of heavy- vs. moderate-load training on the development of strength , power , and throwing ball velocity in male h and ball players . J Strength Cond Res 24(X ) : 000 - 000 , 2010-The aim was to compare the effect of 2 differing 10-week resistance training programs on the peak power ( PP ) output , muscle volume , strength , and throwing velocity of the upper limbs in h and ball players during the competitive season . The subjects were 26 men ( age 20.0 ± 0.6 years , body mass 85.0 ± 13.2 kg , height 1.86 ± 0.06 m , and body fat 13.7 ± 2.4 % ) . They were r and omly assigned to 1 of 3 groups : control ( C ; n = 8) , heavy resistance ( n = 9 ) , or moderate resistance ( MR ; n = 9 ) training , performed twice a week . A force-velocity test on an appropriately modified Monark cycle ergometer determined PP . Muscle volumes were estimated using a st and ard anthropometric kit . One-repetition maximum ( 1RM ) bench press ( 1RMBP ) and 1RM pull-over ( 1RMPO ) scores assessed arm strength . H and ball throwing velocity was measured with ( TR ) and without run-up ( TW ) . Both training programs enhanced absolute PP relative to controls ( p < 0.05 ) , although differences disappeared if PP was expressed per unit of muscle volume . Heavy resistance-enhanced 1RMBP and 1RMPO compared to both MR ( p < 0.01 and p < 0.05 , respectively ) and C ( p < 0.001 for both tests ) . Heavy resistance also increased TR and TW compared to C ( p < 0.01 and p < 0.05 , respectively ) . Moderate resistance increased only TR compared to C ( p < 0.01 ) . Thus , during the competitive season , the PP , 1RMBP , 1RMPO , and TW of male h and ball players were increased more by 10 weeks of bench press and pull-over training with suitably adapted heavy loads than with moderate loads . It would seem advantageous to add such resistance exercise before customary technical and tactical h and ball training sessions Abstract Raeder , C , Fern and ez-Fern and ez , J , and Ferrauti , A. Effects of six weeks of medicine ball training on throwing velocity , throwing precision , and isokinetic strength of shoulder rotators in female h and ball players . J Strength Cond Res 29(7 ) : 1904–1914 , 2015—The aim of this study was to investigate the effects of 6 weeks of medicine ball training ( MBT ) on throwing velocity , throwing precision , and isokinetic strength of shoulder rotators in competitive female h and ball players . Twenty-eight players ( mean ± SD ; age : 20.8 ± 3.3 years , height : 170.5 ± 5.6 cm , body mass : 65.2 ± 8.0 kg ) were r and omly assigned to an MBT group ( TG ; n = 15 ) and a control group ( CG ; n = 13 ) . TG performed a supervised MBT program , 3 times a week for a total of 6 weeks , focusing on h and ball-specific movement patterns . Both groups , TG and CG , also conducted a supervised shoulder injury prevention program with elastic tubes , as part of the warm-up , finishing with regular h and ball throws . Results showed a significant group × time interaction in throwing velocity ( p < 0.001 ) with the TG posttest results being significantly higher compared with CG ( d = 2.1 ) , and also a significant main time effect ( p < 0.001 ) , with an increase in throwing velocity of 14 % ( d = 3.0 ) and 3.7 % ( d = 0.3 ) for both TG and CG , respectively . Throwing precision did not significantly differ between groups and time points . Isokinetic strength measures revealed a significant group × time interaction ( p ⩽ 0.05 ) with the TG posttest results being significantly higher compared with CG ( d = 0.9 ) and also a significant main time effect ( p < 0.01 ) with an increase of 15 % ( d = 0.9 ) in concentric shoulder internal rotation at 180 ° ·s−1 in the dominant arm in TG , whereas no significant changes occurred in CG . The present results indicate that 6 weeks of MBT elicit significant improvements in functional performance ( i.e. , throwing velocity ) in female h and ball players , whereas throwing precision remained unaffected . Medicine ball training exercises seem to be a useful and inexpensive strength training strategy in enhancing functional performance by closely mimicking sport-specific movement activities PURPOSE The purpose of this study was to compare the effects of jump training as a complement to weight training on jump performance and muscle strategy during the squat and countermovement jump . METHOD Twenty-two male h and ball players , between the ages of 17 and 24 , and in good health , were r and omly divided into three groups . Two were trained groups , weight training ( WTG ) and jump training combined with weight training ( CTG ) , and one was a control group ( CG ) . Maximal isometric force and maximal concentric power were assessed by a supine leg press , squat jump ( SJ ) , counter movement jump ( CMJ ) , and surface EMG was used to determine changes in muscle adaptation before and after the training period . RESULTS After 6-wk training programs , the two training groups increased maximal isometric force , maximal concentric power , and squat jump performance . However , only combined training presented a significant increase in height jump performance during the countermovement jump ( P < 0.05 ) . EMG analysis ( as interpreted through the root mean square values ) showed that the SJ was performed similarly before and after the training period for the two training groups . However , during the CMJ , only the CTG group adopted a new technique manifested by a short transition phase together with an increase in knee joint stiffness and knee extensor muscle activation and rectus femoris ratio . CONCLUSION It was suggested that the central activities in knee joint during the transition phase , in conjunction with intrinsic muscle contractile properties , play a major role in the regulation of performance during a CMJ . Furthermore , our study suggests that a change in maximal strength and /or explosive strength does not necessarily cause changes in combined movement such as the stretch shortening cycle Objective Introduction of a neuromuscular training program will increase muscle strength , balance , and proprioception in elite female h and ball players . Design Prospect i ve intervention study . Participants Thirty-five female team h and ball players from 2 teams in the elite division participated . Their mean age was 23 ( ±2.5 ) years , and their mean weight was 69.2 ( ±7.3 ) kg . They had played h and ball for 14.9 ( ±3.2 ) years , 4.7 ( ±2.8 ) years at the top level . The total number of training hours per week was 10 to 11 . InterventionBased on earlier studies and knowledge about common risk situations in team h and ball , an anterior cruciate ligament ( ACL ) injury prevention program with 3 different sets of exercises was developed , each set with a 5-step progression from simple to more challenging exercises . The teams were instructed to use the program a minimum of 3 times a week during a training period of 5 to 7 weeks , and then once a week during the season . The duration of each training session was approximately 15 minutes . Main outcome measures Balance ( KAT 2000 ) , proprioception ( threshold to detection of passive motion ) , muscle strength ( Cybex 6000 ) , and 3 functional knee tests . The players were tested pretraining ( test 1 ) and 8 weeks ( test 2 ) and 12 months ( test 3 ) after the training started . Results There was a significant improvement in dynamic balance between test 1 and test 2 , with a balance index ( BI ) of 924 ( ±225 ) and 778 ( ±174 ) , respectively ( P = 0.01 ) . The effect on dynamic balance was maintained 1 year after training ( BI , 730 ± 156 ) . For static balance , no statistically significant changes were found . For the other variables measured , there were no statistical differences during the study period . Conclusion The ACL injury prevention training program improved dynamic balance in an elite team h and ball players Hermassi , S , Chelly , MS , Tabka , Z , Shephard , RJ , and Chamari , K. Effects of 8-week in-season upper and lower limb heavy resistance training on the peak power , throwing velocity , and sprint performance of elite male h and ball players . J Strength Cond Res 25(9 ) : 2424 - 2433 , 2011—The aims of this study were to test the potential of in-season heavy upper and lower limb strength training to enhance peak power output ( Wpeak ) , vertical jump , and h and ball related field performance in elite male h and ball players who were apparently already well trained , and to assess any adverse effects on sprint velocity . Twenty-four competitors were divided r and omly between a heavy resistance ( HR ) group ( age 20 ± 0.7 years ) and a control group ( C ; age 20 ± 0.1 years ) . Resistance training sessions were performed twice a week for 8 weeks . Performance was assessed before and after conditioning . Peak power ( Wpeak ) was determined by cycle ergometer ; vertical squat jump ( SJ ) and countermovement jump ( CMJ ) ; video analyses assessed velocities during the first step ( V1S ) , the first 5 m ( V5 m ) , and between 25 and 30 m ( Vpeak ) of a 30-m sprint . Upper limb bench press and pull-over exercises and lower limb back half squats were performed to 1-repetition maximum ( 1RM ) . Upper limb , leg , and thigh muscle volumes and mean thigh cross-sectional area ( CSA ) were assessed by anthropometry . Wpeak ( W ) for both limbs ( p < 0.001 ) , vertical jump height ( p < 0.01 for both SJ and CMJ ) , 1RM ( p < 0.001 for both upper and lower limbs ) and sprint velocities ( p < 0.01 for V1S and V5 m ; p < 0.001 for Vpeak ) improved in the HR group . Upper body , leg , and thigh muscle volumes and thigh CSA also increased significantly after strength training . We conclude that in-season biweekly heavy back half-squat , pull-over , and bench-press exercises can be commended to elite male h and ball players as improving many measures of h and ball-related performance without adverse effects upon speed of movement Abstract To investigate the influence of adding a weekly eccentric-overload training ( EOT ) session in several athletic performance ’s tests , 18 team-h and ball players were assigned either to an EOT ( n = 11 ) or a Control ( n = 7 ) group . Both groups continued to perform the same habitual strength training , but the EOT group added one session/week during a 7-week training programme consisting of four sets of eight repetitions for the bilateral half-squat and unilateral lunge exercises . The test battery included h and ball throwing velocity , maximum dynamic strength ( 1RM ) , countermovement jump ( CMJ ) , 20 m sprint , triple hop for distance , and eccentric/concentric power in both the half-squat and lunge exercises . Data were analysed using magnitude-based inferences . Both groups improved their 1RM in the half squat , 20 m sprint time , and CMJ performance to a similar extent , but the EOT group showed a beneficial effect for both right [ ( 42/58/0 ) , possibly positive ] and left [ ( 99/1/0 ) , very likely positive ] triple hop for distance performance . In addition , the EOT group showed greater power output improvements in both eccentric and concentric phases of the half-squat ( difference in percent of change ranging from 6.5 % to 22.0 % ) and lunge exercises ( difference in per cent of change ranging from 13.1 % to 24.9 % ) . Nevertheless , no group showed changes in h and ball throwing velocity . Selected variables related to team-h and ball performance ( i.e. functional jumping performance , power output ) can be improved by adding a single EOT session per week , highlighting the usefulness of this low-volume/high-intensity training when aim ing at optimizing dynamic athletic performance Abstract Chelly , MS , Hermassi , S , Aouadi , R , and Shephard , RJ . Effects of 8-week in-season plyometric training on upper and lower limb performance of elite adolescent h and ball players . J Strength Cond Res 28(5 ) : 1401–1410 , 2014—We hypothesized that replacement of a part of the normal in-season regimen of top-level adolescent h and ball players by an 8-week biweekly course of lower and upper limb plyometric training would enhance characteristics important to competition , including peak power output ( Wpeak ) , jump performance , muscle volume , and ball throwing velocity . Study participants ( 23 men , age : 17.4 ± 0.5 years , body mass : 79.9 ± 11.5 kg , height : 1.79 ± 6.19 m , body fat : 13.8 ± 2.1 % ) were r and omly assigned between controls ( C ; n = 11 ) and an experimental group ( E , n = 12 ) . Measures preintervention and postintervention included force-velocity ergometer tests for upper ( Wupper peak ) and lower limbs ( Wlower peak ) , force platform determinations of squat jump ( SJ ) and countermovement jump ( CMJ ) characteristics ( jump height , maximal force , initial velocity , and average power ) , video filming of sprint velocities ( first step [ V1S ] , first 5 m [ V5 m ] , and 2 Output:

At the multivariate meta-regression , the effect of publication year was significant , as well as the effects of country , gender , and level . Conclusions : RT has a significant impact in h and ball players .

MS2_1shot542

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Purpose Oxaliplatin-induced peripheral neurotoxicity ( OPN ) is frequent and potentially severe , but successful treatment of this condition is still an unmet clinical need . We aim ed to determine whether treatment with goshajinkigan ( TJ-107 ) , a traditional Japanese medicine , is better than placebo in preventing OPN in patients with advanced or recurrent colorectal cancer patients treated with st and ard FOLFOX regimens . Methods In this phase 2 , r and omized , double-blind , placebo-controlled study , patients undergoing oxaliplatin-based chemotherapy were r and omized to receive either oral TJ-107 ( 7.5 g ) or matching placebo daily . The severity of OPN was assessed according to the Common Toxicity Criteria for Adverse Events at baseline , every 2 weeks until the 8th cycle , and every 4 weeks thereafter until the 26th week . The primary endpoint was the incidence of grade 2 or greater OPN until the 8th cycle of chemotherapy . Results Analyses were done by intention to treat . Eighty-nine patients were r and omly assigned to receive either TJ-107 ( n = 44 ) or placebo ( n = 45 ) between May 2009 and March 2010 . The incidence of grade 2 or greater OPN until the 8th cycle was 39 and 51 % in the TJ-107 and placebo groups , respectively ( relative risk ( RR ) , 0.76 ; 95 % CI , 0.47–1.21 ) . The incidence of grade 3 OPN was 7 % ( TJ-107 ) vs. 13 % ( placebo ) ( 0.51 , 0.14–1.92 ) . No concerns regarding toxicity emerged with TJ-107 treatment . Conclusions TJ-107 appears to have an acceptable safety margin and a promising effect in delaying the onset of grade 2 or greater OPN without impairing FOLFOX efficacy IMPORTANCE There are no known effective treatments for painful chemotherapy-induced peripheral neuropathy . OBJECTIVE To determine the effect of duloxetine , 60 mg daily , on average pain severity . DESIGN , SETTING , AND PATIENTS R and omized , double-blind , placebo-controlled crossover trial at 8 National Cancer Institute (NCI)-funded cooperative research networks that enrolled 231 patients who were 25 years or older being treated at community and academic setting s between April 2008 and March 2011 . Study follow-up was completed July 2012 . Stratified by chemotherapeutic drug and comorbid pain risk , patients were r and omized to receive either duloxetine followed by placebo or placebo followed by duloxetine . Eligibility required that patients have grade 1 or higher sensory neuropathy according to the NCI Common Terminology Criteria for Adverse Events and at least 4 on a scale of 0 to 10 , representing average chemotherapy-induced pain , after paclitaxel , other taxane , or oxaliplatin treatment . INTERVENTIONS The initial treatment consisted of taking 1 capsule daily of either 30 mg of duloxetine or placebo for the first week and 2 capsules of either 30 mg of duloxetine or placebo daily for 4 additional weeks . MAIN OUTCOME MEASURES The primary hypothesis was that duloxetine would be more effective than placebo in decreasing chemotherapy-induced peripheral neuropathic pain . Pain severity was assessed using the Brief Pain Inventory-Short Form " average pain " item with 0 representing no pain and 10 representing as bad as can be imagined . RESULTS Individuals receiving duloxetine as their initial 5-week treatment reported a mean decrease in average pain of 1.06 ( 95 % CI , 0.72 - 1.40 ) vs 0.34 ( 95 % CI , 0.01 - 0.66 ) among those who received placebo ( P = .003 ; effect size , 0.513 ) . The observed mean difference in the average pain score between duloxetine and placebo was 0.73 ( 95 % CI , 0.26 - 1.20 ) . Fifty-nine percent of those initially receiving duloxetine vs 38 % of those initially receiving placebo reported decreased pain of any amount . CONCLUSION AND RELEVANCE Among patients with painful chemotherapy-induced peripheral neuropathy , the use of duloxetine compared with placebo for 5 weeks result ed in a greater reduction in pain . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00489411 Background Peripheral sensory neurotoxicity is a frequent adverse effect of oxaliplatin therapy . Calcium and magnesium ( Ca/Mg ) infusions are frequently used as preventatives , but a recent phase III trial failed to show that they prevent neurotoxicity . We therefore conducted a multicenter r and omized phase III trial to compare fluorouracil , leucovorin , and oxaliplatin ( mFOLFOX6 ) with and without Goshajinkigan ( GJG ) , a traditional Japanese herbal medicine ( Kampo ) , to determine GJG ’s potential for reducing peripheral neuropathy in patients with colorectal cancer . Methods Patients with colon cancer who were undergoing adjuvant therapy with infusional mFOLFOX6 were r and omly assigned to GJG ( 7.5 mg three times daily ) or placebo in a double-blind manner . The primary endpoint was the time to grade 2 or greater neuropathy , which was determined at any point during or after oxaliplatin-based therapy using version 3 of the National Cancer Institute Common Terminology Criteria for Adverse Events ( NCI CTCAE ) . Findings An interim analysis was performed when 142 of the planned 310 patients had been enrolled and the safety assessment committee recommended that the study be discontinued . One hundred eighty-two patients were evaluable for response . They included 89 patients in the GJG group and 93 patients in the placebo group . The incidence of grade 2 or greater neurotoxicity was 50.6 % in the GJG group and 31.2 % in the placebo group . A Cox proportional hazards analysis indicated that the use of GJG was significantly associated with the incidence of neuropathy ( hazard ratio , 1.908 ; p = 0.007 ) . Conclusion Goshajinkigan did not prevent oxaliplatin-associated peripheral neuropathy in this clinical trial . The clinical study was therefore terminated IMPORTANCE Chemotherapy-induced peripheral neuropathy ( CIPN ) is a common adverse effect of neurotoxic chemotherapy result ing in pain , sensory loss , and decreased quality of life . Few studies have prospect ively examined the relationship between sensory neuropathy symptoms , falls , and fall-related injuries for patients receiving neurotoxic chemotherapy . OBJECTIVE To determine the association between the symptoms of CIPN and the risk of falls for patients receiving neurotoxic chemotherapy . DESIGN , SETTING , AND PARTICIPANTS In this secondary analysis of a prospect i ve study , 116 patients with breast , ovarian , or lung cancer who were beginning neurotoxic chemotherapy with a taxane or platinum agent were recruited from oncology clinics . These patients would call a novel automated telephone system daily for 1 full course of chemotherapy . The telephone system ( SymptomCare@Home ) used a series of relevant CIPN questions to track symptoms on a 0 to 10 ordinal scale and contained a question naire about falls . Those reporting a numbness and tingling severity score of 3 or greater for at least 10 days were considered to have significant CIPN symptoms and were compared with those patients who did not . Data analysis was performed in November 2015 . EXPOSURE Chemotherapy with a neurotoxic taxane or platinum agent . MAIN OUTCOMES AND MEASURES Patient-reported falls or near falls and fall-related injuries . The hypothesis was generated after data collection but prior to data analysis . RESULTS Of the 116 patients who started neurotoxic chemotherapy ( mean [ SD ] age was 55.5 [ 11.9 ] years , and 109 [ 94.0 % ] were female ) , 32 met the predetermined criteria for CIPN symptoms . The mean duration of follow-up was 62 days , with 51 telephone calls completed per participant . Seventy-four falls or near falls were reported . The participants with CIPN symptoms were nearly 3 times more likely to report a fall or near fall than the participants without CIPN symptoms ( hazard ratio , 2.67 [ 95 % CI , 1.62 - 4.41 ] ; P < .001 ) . The participants with CIPN symptoms were more likely than the participants without CIPN symptoms to obtain medical care for falls ( 8 of 32 participants with CIPN symptoms [ 25.0 % ] vs 6 of 84 participants without CIPN symptoms [ 7.1 % ] ; P = .01 ) . CONCLUSIONS AND RELEVANCE These findings suggest that the sensory symptoms of CIPN are an indicator of an increased risk of falling and an increased use of health care re sources . This study demonstrates the utility of a novel telephone-based system to track neuropathy symptoms . Careful monitoring and coaching of patients receiving neurotoxic chemotherapy for new sensory symptoms may facilitate more effective fall prevention strategies Goshajinkigan , a herbal medicine , has long been used in Japan to alleviate the subjective symptoms of diabetic neuropathy ; however , its effects have not been confirmed objective ly . We evaluated its effects on subjective symptoms and on vibration sensation in patients with diabetic neuropathy . The oral administration of 7.5 g/day of Goshajinkigan for 3 months ( treatment period ) relieved subjective symptoms of numbness in 9 of 13 patients . When the drug was discontinued for 2 months as a washout period , the subjective symptom worsened in 7 of 13 patients . Chi-square analysis revealed significant effects of Goshajiniagan on subjective symptoms ( P < 0.001 for numbness and P < 0.05 for cold sensation ) . Vibration sensation was evaluated by measuring vibratory threshold using an SMV-5 vibrometer . There were significant changes in vibratory thresholds by paired t-test ( P < 0.05 ) both in the upper and the lower extremities during the treatment and washout periods . Chi-square analysis also revealed a significant effect of Goshajinkigan on vibratory threshold ( P < 0.01 ) . There was no significant change in glycosylated hemoglobin as a whole during the study . These observations confirm that Goshajinkigan relieves subjective symptoms and demonstrate that it improves vibration sensation in patients with diabetic neuropathy BACKGROUND Goshajinkigan ( GJG ) is used for the treatment of several neurological symptoms . We investigated the efficacy of GJG and mecobalamin ( B12 ) against neurotoxicity associated with docetaxel ( DOC ) in breast cancer patients . MATERIAL S AND METHODS Sixty breast cancer patients were treated with DOC . Thirty-three patients ( GJG group ) received oral administration of 7.5 g/day GJG and 27 patients ( B12 group ) received oral administration of 1500 μg/day B12 . Neuropathy was evaluated according to DEB-NTC ( Neurotoxicity Criteria of Debiopharm ) , Common Terminology Criteria for Adverse Events ( NCI-CTC ) ver . 3.0 , and a visual analogue scale ( VAS ) . This study employed a r and omized open design . RESULTS The incidence of neuropathy was 39.3 % in the GJG group , and 88.9 % in the B12 group ( p<0.01 ) . In the GJG group , grade 1 DEB-NTC was observed in 2 cases , grade 2 in 5 cases and grade 3 in 5 cases . Grade 1 NCI-CTC was observed in 7 cases , grade 2 in 6 cases , and VAS was 2.7 ± 2.2 . In the B12 group , grade s 1 , 2 and 3 DEB-NTC were observed in one case , 12 cases and 12 cases , respectively ; and grade s 1 , 2 and 3 NCI-CTC were observed in 11 cases , 12 cases and one case , and VAS was 4.9 ± 2.4 . CONCLUSIONS Concomitant administration of GJG is useful in preventing neuropathy in breast cancer patients treated with a DOC regimen Output:

Conclusions Goshajinkigan tended to prevent persistence but not severity of CIPN .

MS2_1shot543

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Alloantibodies against HLA antigens can be reduced by applying leukodepletion to transfusions . Because the importance of immunological and nonimmunological causes of poor platelet transfusion results using leukodepleted transfusions is not clear , we conducted a prospect i ve study in an unselected patient population receiving leukodepleted transfusions . In 97 patients with hematological malignancies , 181 r and om leukodepleted platelet transfusions were studied for immunological causes of poor platelet transfusion results by calculating the odds ratio of four different screening tests for a low platelet recovery . Nonimmune causes were also studied by calculating the odds ratio of the most prevalent nonimmune causes for a low platelet recovery . No single screening test showed an association with recovery after 1 and 16 h following a platelet transfusion . The combination of a positive enzyme-linked immunosorbent assay ( ELISA ) and platelet immunofluorescence test ( PIFT ) or a combination of a positive lymphocyte immunofluorescence test ( LIFT ) and PIFT , demonstrating an association with a low platelet recovery after 16 h , was present in 2 % of all platelet transfusions . Of nonimmune causes , splenomegaly and storage time of platelets for more than 3 days were associated with low platelet recovery after 1 h and 16 h of being present in 29 % and 47 % of all platelet transfusions , respectively . Immunological causes account for a small proportion of poor platelet transfusion results compared to nonimmunological causes in a nonselected patient population receiving leukodepleted transfusions Seventy-nine platelet transfusions to 73 thrombocytopenic patients with cancer were analyzed to determine whether a platelet count obtained one hour after transfusion could help differentiate between alloimmunization and other clinical factors that result in rapid platelet destruction . These transfusions were selected because 18- to 24-hour increments were inadequate in response to fresh , r and om donor platelets . A corrected count increment ( Cl ) ( Cl=[posttransfusion count-pretransfusion count]Xbody surface area [ sq m]/platelets transfusedX10 ' ' ) at one hour of 10X103/microliter or greater was associated with absence of lymphocytotoxic antibody , whereas increments of less than 10X103/microliter were generally associated with high levels of strongly cytotoxic antibody . HLA-matched transfusions produced no improvement in increments when the previous one-hour Cl had been 10X103/microliter or greater , whereas in the other group significantly better increments were obtained . A one-hour posttransfusion count is a simple test that correlates well with the presence of antibody against HLA antigens , is valuable in predicting the need for HLA-matched platelets , and helps avoid wasteful , empirical use of such transfusions Immune and nonimmune causes of platelet refractoriness were evaluated in a group of patients receiving HLA‐selected single‐donor platelet transfusions . During a 1‐year observation period , 1 h and 24 h platelet recoveries were determined after 522 single‐donor platelet transfusions given to 43 patients persistently refractory to pooled r and om‐donor platelet transfusions . 72 % of patients tested ultimately developed lymphocytotoxic antibodies suggesting they were alloimmunized . When significant lymphocytotoxic antibodies were demonstrable in these patients , HLA well‐matched platelet transfusions consistently produced good transfusion responses . In contrast , patients without lymphocytotoxic antibodies had clinical factors that adversely affected transfusion outcome ( P < 0.0001 ) . Fever and splenomegaly markedly reduced 1 h post‐transfusion platelet recoveries , while sepsis compromised the 24 h platelet recovery . Overall , the presence of any clinical factor was most likely to reduce 1 h platelet recovery , while donor‐recipient HLA incompatibilities correlated best with poor 24 h posttransfusion platelet recovery A variety of patient and product-related factors influenced the outcome of 6379 transfusions given to 533 patients in the Trial to Reduce Alloimmunization to Platelets ( TRAP ) . Responses measured were platelet increments , interval between platelet transfusions , and platelet refractoriness . Patient factors that improved platelet responses were splenectomy and increasing patient age . In contrast , at least 2 prior pregnancies , male gender , splenomegaly , bleeding , fever , infection , disseminated intravascular coagulation , increasing height and weight , lymphocytotoxic antibody positivity , an increasing number of platelet transfusions , or receiving heparin or amphotericin were associated with decreased posttransfusion platelet responses . Platelet factors that were associated with improved platelet responses were giving ABO-compatible platelets , platelets stored for 48 hours or less , and giving large doses of platelets while ultraviolet B ( UV-B ) or gamma irradiation decreased platelet responses . However , in alloimmunized lymphocytoxic antibody-positive patients , the immediate increment to UV-B-irradiated platelets was well maintained , whereas all other products showed substantial reductions . Refractoriness to platelet transfusions developed in 27 % of the patients . Platelet refractoriness was associated with lymphocytotoxic antibody positivity , heparin administration , fever , bleeding , increasing number of platelet transfusions , increasing weight , at least 2 pregnancies , and male gender . The only factors that reduced platelet refractoriness rates were increasing the dose of platelets transfused or transfusing filtered apheresis platelets R and omized controlled trials have shown a reduction in platelet alloimmunization and refractoriness in patients with acute leukemia ( AL ) with the use of poststorage leukoreduction of blood products . Universal prestorage leukoreduction ( ULR ) of red cell and platelet products has been performed in Canada since August 1999 . We conducted a retrospective analysis of 13 902 platelet transfusions in 617 patients undergoing chemotherapy ( CT ) for AL or stem cell transplantation ( SCT ) before ( n = 315 ) and after ( n = 302 ) the introduction of ULR . Alloimmunization was significantly reduced ( 19 % to 7 % , P < .001 ) in the post-ULR group . Alloimmune platelet refractoriness was similarly reduced ( 14 % to 4 % , P < .001 ) . Fewer patients in the post-ULR group received HLA-matched platelets ( 14 % vs 5 % , P < .001 ) . Alloimmunization and alloimmune refractoriness in the 318 patients who were previously pregnant and /or transfused were also reduced after ULR ( P = .023 and P = .005 , respectively ) . In a Cox regression model , the 3 independent factors that predicted for alloimmune refractoriness were nonleukoreduced blood products ( relative risk [ RR ] , 2.2 [ 95 % CI , 1.2 - 4.3 ] ) , a history of pregnancy and /or transfusion ( RR , 2.3 [ 95 % CI , 1.3 - 4.2 ] ) , and receipt of 13 or more platelet transfusions ( RR , 6.0 [ 95 % CI , 2.4 - 15.3 ] ) . In conclusion , ULR reduces alloimmunization , refractoriness , and requirements for HLA-matched platelets when applied as routine transfusion practice to patients receiving CT or SCT A critical factor limiting the availability of histocompatible platelet transfusions for alloimmunized , thrombocytopenic patients is the large pool of HL‐typed donors needed to procure platelets perfectly matched for HLA antigens . We have , therefore , investigated the effectiveness of platelets obtained from donors having lesser degrees of histocompatibility . In 421 transfusions administered to 59 alloimmunized patients who were refractory to “ r and om donor ” platelets , it was found that platelets mismatched for 1 or 2 “ cross‐reactive ” HLA antigens were in most instances as effective in increasing circulating platelet levels as perfectly matched platelets . A significant number of patients also responded to platelets from donors selectively mismatched for non‐cross‐reactive HLA antigens . The latter group had a significantly reduced frequency of the antigen HLA‐A2 ( 13 % ) in comparison to the total patient population ( 49 % ) . Use of donors whose HLA antigens are serologically cross‐reactive with those of alloimmunized patients provides approximately 10 times as many prospect i ve donors as does selection based on matching for HLA and simplifies the procurement of hemostatically effective platelets for such patients Alloantibody tests demonstrate immunological causes of insufficient increments in r and om platelet transfusions . The value of a positive or negative test result in predicting the outcome of human leucocyte antigen (HLA)‐matched transfusions in patients refractory to leucodepleted r and om platelet transfusions has not been assessed . We retrospectively evaluated the outcome of the first HLA‐matched platelet transfusion in 72 patients with haematological diseases in two ways : first , the strategy according to which the patient was selected for HLA‐matched platelet transfusions was analysed . The strategies were : ( i ) results of alloantibody tests were not available , ( ii ) a positive alloantibody test , ( iii ) a negative alloantibody test . Secondly , the outcome of the first HLA‐matched transfusion was investigated relative to the results of alloantibody tests , irrespective of the decision strategy . No significant association was found between the decision strategy and the outcome of the first HLA‐matched platelet transfusion . Positive alloantibody tests , however , predicted a better outcome of the first HLA‐matched platelet transfusion ( P = 0·04 and P = 0·03 after 1 and 16 h respectively ) . In patients refractory to r and om platelet transfusions , positive alloantibody tests predicted a better outcome of HLA‐matched platelet transfusions . Patients with negative alloantibody tests , however , may benefit from HLA‐matched platelet transfusions Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Repeated platelet transfusion to thrombocytopenic patients frequently induce anti HLA antibodies , which are responsible for transfusion refractoriness . As the transfused platelet suspensions usually contain 15 - 30 % of the leukocytes originally present in the blood , it is not known whether these antibodies are raised by the platelets or by the contaminating leukocytes in the platelet suspensions . In the mouse , pure platelet suspensions are not able to induce a primary antibody response , as measured by the NIH test and the indirect immunofluorescence test on platelets and leukocytes , despite repeated injections . However , when the platelet suspensions are contaminated with leukocytes ( 10(3 ) or more/injection ) an antibody response is induced . This response is higher than the response indiced by an equal amount of leukocytes alone . As in man the use of leukocyte poor platelets postpones the development of refractoriness to r and om platelets it is concluded that transfusions with leukocyte free platelets will probably prevent immunization against the HLA antigens This study describes a novel application of HLAMatchmaker to determine platelet compatibility in 16 alloimmunized patients with aplastic anemia refractory to r and om donor platelet transfusions . HLAMatchmaker is a software algorithm that predicts HLA compatibility by identifying immunogenic epitopes represented by amino acid triplets in antibody-accessible regions of human leukocyte antigen ( HLA ) molecules and determines the number of triplet mismatches ( TMMs ) and highly immunogenic triplet mismatches ( HIMMs ) . Corrected count increments ( CCIs ) and molecular HLA typing were available for 523 transfusions . Conventional compatibility assessment based on cross-reactive group ( CREG ) determination was not predictive of transfusion outcome . Low HIMMs and TMMs numbers were associated with a higher likelihood of satisfactory ( CCIs > or = 8) compared with unsatisfactory ( CCIs < 8) outcomes ( median HIMMs = 4 vs 6 , p2 value < .001 ; median TMMs = 11 vs 13 , p2 value < .001 ) . Although receiver operator characteristic curves revealed that HIMMs or TMMs number are not powerful predictors of individual transfusion outcome , a threshold of at least 3 HIMMs or at least 9 TMMs appeared to be associated with successful transfusions . Triplet-matched transfusions were successful , regardless of CREG matching . Our data vali date HLAMatchmaker for platelet transfusions and demonstrate its potential to refine and exp and donor selection for HLA-alloimmunized patients We implemented a prospect i ve study to evaluate platelet transfusion utilization , re source use , and costs in a tertiary care hospital over a 6‐month period . All hospitalized patients receiving platelet transfusions between July and December 1996 were followed prospect ively to determine platelet use and costs . Clinical and financial data were collected , evaluated , and compared to identify trends in re source utilization based on admitting service and platelet‐refractory status . One thous and nine hundred forty‐four platelet units were transfused to 245 hospitalized patients ( Output:

HLA-matched PLTs did not reduce alloimmunization and refractoriness rates beyond that offered by leukoreduction , and utilization was not consistently improved . HLA-matched PLTs led to better 1-hour posttransfusion count increments and percentage of PLT recovery in refractory patients ; however , the effect at 24 hours was inconsistent .

MS2_1shot544

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: One hundred twenty-three male veterans were r and omly assigned to control , education , and psychological groups to improve oral hygiene behavior . The educational group received four 40-min sessions design ed to increase knowledge of the causes and prevention of dental disease . The psychological intervention also consisted of four 40-min sessions . However , a psychologist provided the intervention using a Stage of Change intervention . The control group received pre- and post-testing only . There were no significant changes in dental knowledge for the control group while the increases in dental knowledge in the educational and psychological groups were similar and statistically significant . Pre-Post change scores for flossing self-efficacy scores showed significant changes for all groups . The magnitude of changes was similar when the control and educational groups were compared . In contrast , the psychological intervention group demonstrated significantly greater flossing self-efficacy changes when compared to either the control or the educational groups . These results suggest that increases in self-efficacy may be an important component of interventions design ed to change health behavior and may serve a role in evaluating and comparing the efficacy of these interventions PURPOSE The proximate use of illicit drugs or alcohol ( substance use ) is the most common precipitator of facial injuries among socioeconomically disadvantaged population s. Reducing these risky behaviors could minimize adverse health sequelae and potential reinjury . The objective of our study was to test whether a culturally competent , personalized motivational intervention incorporated into surgical care could significantly reduce existing substance use behaviors in facial injury patients . PATIENTS AND METHODS Substance-using subjects ( n = 218 ) presenting with facial injuries to a level 1 trauma center were r and omly assigned to either a personalized motivational intervention ( PMI ) condition or a health-information ( HI ) control condition . After a brief assessment of the individual 's substance use severity and willingness to change these behaviors , both groups attended 2 counseling sessions with a trained interventionist . The PMI subjects ( n = 118 ) received individualized , motivational interventions , whereas the HI subjects ( n = 100 ) received only general health information . Both groups were reassessed at 6 and 12 months postinjury , and changes in substance-use patterns were measured to assess the effects of intervention . RESULTS The PMI and HI groups were closely matched on their sociodemographic and substance use characteristics . Subjects in the PMI group showed statistically significant declines in drug use at both the 6- and 12-month assessment s. The intervention 's effect on lowering illicit drug use was greatest at the 6-month assessment but had weakened by the 1-year follow-up . The efficacy of the PMI was moderated by an individual 's initial drug use severity ; individuals with greater drug use dependency at baseline were seen to have larger intervention effects , as did individuals who were most aware of their drug problem and willing to change their substance use behaviors . Unlike illicit drug use , changes in alcohol use did not differ significantly between the intervention and control groups , irrespective of an individuals ' recognition of the alcohol problem or willingness to take steps to address it . CONCLUSION A culturally competent , motivational intervention integrated into the care of vulnerable patients with facial injury can reduce illicit drug use behaviors . Subgroups of injured patients appear to benefit most from such personalized motivational interventions . A better articulation of target population s , intervention content , and delivery would allow for directed interventions and an appropriate focusing of limited time and health care re sources We describe a r and omized trial design ed to evaluate the effectiveness of a smokeless tobacco cessation intervention delivered by dental hygienists as part of a patient 's regularly scheduled cleaning visit . Seventy-five practice s were r and omized to continue their usual care ( n=25 ; 239 smokeless tobacco using patients enrolled ) or to receive training to provide a tobacco cessation intervention ( n=50 ; 394 smokeless tobacco using patients enrolled ) . Patient reports indicated that the training program was successful in getting hygienists to implement the intervention . The intervention produced a strong effect on sustained quitting for smokeless tobacco users but had no impact on secondary outcomes , including unsuccessful quit attempts , future intent to quit using smokeless tobacco , and change in readiness to quit using . Frequency of smokeless tobacco use and receipt of specific components of the intervention , including the video and written material s , predicted sustained cessation . Since this intervention was delivered by dental hygienists as part of a patient 's regularly scheduled cleaning visit , it is easily disseminable OBJECTIVES This pragmatic r and omized trial evaluated the effectiveness of a tailored educational intervention on oral health behaviors and new untreated carious lesions in low-income African-American children in Detroit , Michigan . METHODS Participating families were recruited in a longitudinal study of the determinants of dental caries in 1021 r and omly selected children ( 0 - 5 years ) and their caregivers . The families were examined at baseline in 2002 - 2004 ( Wave I ) , 2004 - 2005 ( Wave II ) and 2007 ( Wave III ) . Prior to Wave II , the families were r and omized into two educational groups . An interviewer trained in applying motivational interviewing principles ( MI ) review ed the dental examination findings with caregivers assigned to the intervention group ( MI + DVD ) and engaged the caregiver in a dialogue on the importance of and potential actions for improving the child 's oral health . The interviewer and caregiver watched a special 15-minute DVD developed specifically for this project based on data collected at Wave I and focused on how the caregivers can ' keep their children free from tooth decay ' . After the MI session , the caregivers developed their own preventive goals . Some families in this group chose not to develop goals and were offered the project-developed goals . The goals , if defined , were printed on glossy paper that included the child 's photograph . Families in the second group ( DVD-only ) were met by an interviewer , shown the DVD , and provided with the project 's recommended goals . Both groups of families received a copy of the DVD . Families in the MI + DVD group received booster calls within 6 months of the intervention . Both caregivers and the children were interviewed and examined after approximately 2 years ( Wave III : 2007 ) . RESULTS After 6-month of follow-up , caregivers receiving MI + DVD were more likely to report checking the child for ' precavities ' and making sure the child brushes at bedtime . Evaluation of the final outcomes approximately 2 years later found that caregivers receiving the MI + DVD were still more likely to report making sure the child brushed at bedtime , yet were no more likely to make sure the child brushed twice per day . Despite differences in one of the reported behaviors , children whose caregivers received the motivational intervention did not have fewer new untreated lesions at the final evaluation . CONCLUSIONS This study found that a single motivational interviewing intervention may change some reported oral health behaviors , it failed to reduce the number of new untreated carious lesions This cluster-r and omized pragmatic ( effectiveness ) trial tested maternal counseling based on Motivational Interviewing ( MI ) as an approach to control caries in indigenous children . Nine Cree communities in Quebec , Canada were r and omly allocated to test or control . MI-style counseling was delivered in test communities to mothers during pregnancy and at well-baby visits . Data on outcomes were collected when children were 30 months old . Two hundred seventy-two mothers were recruited from the 5 test and 4 control communities . Baseline characteristics were comparable but not equivalent for both groups . At trial ’s end , 241 children had follow-up . The primary analysis outcome was enamel caries with substance loss ( d2 ) ; no statistically significant treatment effect was detected . Prevalence of treated and untreated caries at the d2 level was 76 % in controls vs. 65 % in test ( p = 0.17 ) . Exploratory analyses suggested a substantial preventive effect for untreated decay at or beyond the level of the dentin , d3 ( prevalences : 60 % controls vs. 35 % test ) , and a particularly large treatment effect when mothers had 4 or more MI-style sessions . Overall , these results provide preliminary evidence that , for these young , indigenous children , an MI-style intervention has an impact on severity of caries ( clinical trial registration IS RCT N41467632 ) OBJECTIVES Primary care medical clinics are good setting s for smoking interventions . This study extends this strategy with a smokeless tobacco intervention delivered by dentists and dental hygienists in the course of routine dental care . METHODS Male users of moist snuff and chewing tobacco ( n = 518 ) were identified by question naire in clinic waiting rooms and then r and omly assigned to either usual care or intervention . The intervention included a routine oral examination with special attention to the part of the mouth in which tobacco was kept and an explanation of the health risks of using smokeless tobacco . After receiving unequivocal advice to stop using tobacco , each patient viewed a 9-minute videotape , received a self-help manual , and was briefly counseled by the dental hygienist . RESULTS Long-term success was defined as no smokeless tobacco use at both 3- and 12-month follow-ups , with those lost to follow-up counted as smokeless tobacco users . The intervention increased the proportion of patients who quit by about one half ( 12.5 % vs 18.4 % , P < .05 ) . CONCLUSIONS These results demonstrate the efficacy of a brief dental office intervention for the general population of smokeless tobacco users AIM To develop and test the methodology of an intervention to reduce avoidance of dental care among adolescents , and to measure the respondents ' beliefs regarding the intervention ( credibility and cognitions ) . METHODS Based on a group comparison design a sample of 18 year olds ( n=50 ) with dental non-attendance behaviour was r and omly selected to three experimental and one control group . Subjects were surveyed with one baseline question naire and one post-intervention question naire , to evaluate their beliefs regarding the program . Two different instruments were tested : 1 ) cards representing different statements related to previous dental experiences , possible reasons for attending ( pros ) and not attending ( cons ) dental appointments , and preferences for future treatment . Cards were selected based on individual priority ; 2 ) a brief , structured telephone interview based on Motivational Interviewing . The instruments were tested separately ( groups I and II ) and in combination ( group III ) . Subjects in the control group ( group IV ) were given conventional health education . RESULTS Subjects in the experimental groups had significantly higher credibility scores to the statement " How much easier do you perceive dental treatment to be for you , based on this program " , compared with the control group ( p<0.05 ) . They had also more positive beliefs to the statement " I think the interviewer liked to talk to me " ( p<0.05 ) than controls . CONCLUSION A question naire sent to non-attending adolescents followed by a brief telephone call based on Motivational Interviewing appears to be a credible intervention for adolescents avoiding dental care AIM Because patient adherence to oral hygiene is essential for periodontal treatment success , the aim of the study was to assess whether a motivational interview addressing the five dimensions of Leventhal 's theory performed better than conventional basic instruction on improving compliance with plaque control among patients with periodontitis . MATERIAL S AND METHODS A r and omized controlled clinical trial design was used in which a group of patients underwent a motivational interview in addition to classical consultation . A control group received only the st and ard consultation . The O'Leary Plaque Index was used to judge the oral hygiene at baseline and at 1 month follow-up . Patient satisfaction with the dental visit was scored using a specific question naire . RESULTS At baseline , the mean full mouth plaque score varied between 55 % ( experimental group ) and 58 % ( control group ) . Patients in the experimental group had a higher oral hygiene improvement ( 21 ± 20 % versus 4 ± 5 % , p < 0.001 ) 1 month post-treatment . The motivational interview result ed in greater satisfaction scores compared with those of patients in the control group : 10.55 ± 1.53 versus 8.82 ± 2.40 , p = 0.014 . CONCLUSIONS This new concept of motivational interview is a promising approach and can be useful for counselling-related periodontal disorders AIM To evaluate the effectiveness of an individually tailored oral health educational programme for oral hygiene self-care in patients with chronic periodontitis compared with the st and ard treatment . MATERIAL AND METHOD A r and omized , evaluator-blinded , controlled trial with two different active treatments were used with 113 subjects ( 60 females and 53 males ) r and omly allocated to an experimental or a control group . The individually tailored oral health educational programme was based on cognitive behavioural principles and the individual tailoring for each participant was based on participants ' thoughts , intermediate , and long-term goals , and oral health status . The effect of the programmes on gingivitis [ gingival index ( GI ) ] , oral hygiene [ plaque indices ( PlI ) and self-report ] , and participants ' global rating of treatment was evaluated 3 and 12 months after oral health education and non-surgical treatment . RESULTS Between baseline and the 12-month follow-up , the experimental group improved both GI and PlI more than the control group . The mean gain-score difference was 0.27 for global GI [ 99.2 % confidence interval ( CI ) : 0.16 - 0.39 , p<0.001 ] and 0.40 for proximal GI ( 99.2 % CI : 0.27 - 0.53 , p<0.001 ) . Output:

CONCLUSIONS Review ed r and omized controlled trials showed varied success of MI in improving oral health .

MS2_1shot545

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Cold-stimulated adaptive thermogenesis in brown adipose tissue ( BAT ) to increase energy expenditure is suggested as a possible therapeutic target for the treatment of obesity . We have recently shown high prevalence of BAT in adult humans , which was inversely related to body mass index ( BMI ) and body fat percentage ( BF% ) , suggesting that obesity is associated with lower BAT activity . Here , we examined BAT activity in morbidly obese subjects and its role in cold-induced thermogenesis ( CIT ) after applying a personalized cooling protocol . We hypothesize that morbidly obese subjects show reduced BAT activity upon cold exposure . Methods and Findings After applying a personalized cooling protocol for maximal non-shivering conditions , BAT activity was determined using positron-emission tomography and computed tomography ( PET-CT ) . Cold-induced BAT activity was detected in three out of 15 morbidly obese subjects . Combined with results from lean to morbidly obese subjects ( n = 39 ) from previous study , the collective data show a highly significant correlation between BAT activity and body composition ( P<0.001 ) , respectively explaining 64 % and 60 % of the variance in BMI ( r = 0.8 ; P<0.001 ) and BF% ( r = 0.75 ; P<0.001 ) . Obese individuals demonstrate a blunted CIT combined with low BAT activity . Only in BAT-positive subjects ( n = 26 ) mean energy expenditure was increased significantly upon cold exposure ( 51.5±6.7 J/s versus 44.0±5.1 J/s , P = 0.001 ) , and the increase was significantly higher compared to BAT-negative subjects ( + 15.5±8.9 % versus + 3.6±8.9 % , P = 0.001 ) , indicating a role for BAT in CIT in humans . Conclusions This study shows that in an extremely large range of body compositions , BAT activity is highly correlated with BMI and BF% . BAT-positive subjects showed higher CIT , indicating that BAT is also in humans involved in adaptive thermogenesis . Increasing BAT activity could be a therapeutic target in ( morbid ) obesity The cage systems commonly used for housing laboratory rats often result in sedentary and overweight animals , as a consequence of restricted opportunities for physical activity combined with ad libitum feeding . This can have implication s both for animal well-being and for the experimental outcome . Physical activity has several known positive effects on health and lifespan , and physical fitness might therefore be incorporated into the animal welfare concept . The aim of this study was to investigate if and how pen housing affects the physical activity and fitness of rats . Thirty-two juvenile male Sprague-Dawley rats were r and omly assigned to two different housing systems for a 4-week period . Sixteen rats were kept individually in st and ard Makrolon type III cages ( 42 × 26 × 18 cm ) furnished with black plastic tubes ( singly-housed , SI ) . The remaining rats were kept in groups of eight , housed in large floor pens ( 150 × 210 cm ) , which were furnished with various objects to increase environmental complexity ( pen-housed , PH ) . The body weight gain , and food and water intake of the rats were measured . During weeks 3 or 4 , home cage behaviour , urinary cortiosterone/creatinine ratios ( CO/CR ) , and muscle strength on an inclined plane , were measured . Enzyme activities and glycogen content were measured in tissue sample s from m. triceps brachii taken after euthanization at the end of the study . There were no significant differences between groups for food and water intake , but PH rats weighed 14 % less than SI rats after 4 weeks , and PH rats also had a more diverse behavioural pattern than SI rats . PH rats had significantly higher oxidative capacity ( 28 % more citrate synthase ( CS ) ) and greater glycogen content ( 28 % ) in their muscle sample s than SI rats . The PH rats performed significantly better on the inclined plane , both in the muscle strength test ( mean angle 75 ± 0.5 ° for PH rats and 69 ± 0.4 ° for SI rats ) and the endurance strength test ( mean time 233 ± 22 s for PH rats and 73 ± 14 s for SI rats ) . There was a negative correlation between body weight and results on the inclined plane for the PH rats . There were no significant differences between housing types with respect to CO/CR ratios . In conclusion , the large pen represents an environment that stimulates physical activity and more varied behaviour , which should be beneficial for the welfare of the animal Currently , environmental enrichment is a very common means of improving animal well-being , especially for laboratory animals . Although environmental enrichment seems to be a possible way for improving the well-being of animals , the consideration of housing laboratory animals should not only focus solely on animal well-being , manpower and economics but also on the precision and accuracy of the experimental results . The purpose of the present study was to evaluate the effects of enriched cages ( nest box , nesting material , climbing bar ) on body weight , haematological data and final organ weights . BALB/c , C57BL/6 and A/J mice , originated from Harlan Winkelmann , were used for the experiments - 16 animals of each strain . Animals at 3 weeks of age were marked and separated r and omly to enriched or non-enriched cages , in groups of four , half for each housing condition . Both cages were type III Makrolon cages , only the enriched cages contained a nest box , a wood bar for climbing and nesting material . Animals were kept in a clean animal room under specific pathogen free ( SPF ) conditions . Body weights were recorded every week . Blood sample s were collected at 14 weeks of age ( white blood cells ( WBC ) , red blood cells ( RBC ) , haemoglobin ( HGB ) , and haematocrit ( HCT ) were analysed ) . At 15 weeks of age , the animals were euthanized by CO2 in their home cages , and final body weight and organ weights ( heart , liver , kidney , adrenal , spleen and uterus ) were recorded immediately . Although nearly all the test variables were not affected by environmental enrichment in their mean values , the enriched group showed higher coefficients of variation in many variables , and strain differences of both housing conditions were not consistent . The influences of enrichment were shown to be strain- and test-dependent . Such effects may lead to an increase in the number of animals which is necessary or may change the experimental results , especially when a study , using enriched housing conditions , focuses on strain differences . Since the same enrichment design can result in different influences , a positive or a negative or no adverse effect , due to the strain and the variables studied , research ers need to collect more information before enrichment design s are introduced into experimental plans Ad libitum fed male Sprague-Dawley rats were r and omly assigned to be housed individually ( n=32 ) or four in each cage ( n=32 ) from five to 23 months of age . Body weight and body composition by bioimpedance analysis were monitored longitudinally . An equation for analysis of body composition was developed . Deaths and causes of death were recorded . Of the individually housed animals ( H1 ) 16 percent died , while 44 percent of those housed four in a cage ( H4 ) died , the most common causes of death being circulatory failure , nephritis and tumours of the hypophysis . Body weight increased in both groups over time , significantly more for H4 from 6months of age . Both fat free mass and total body fat increased in both groups over time . Fat in percent of body weight increased up to an age of 14months . H4 animals had significantly more fat from 11 to 20 months of age but lost weight , mostly fat when approaching 23months of age . The occiput-sacrum length of the animals increased up to 11months of age and stayed then constant . Animals in both groups grew also in the cross-sectional dimension . The H1 animals continued to grow all the time , while the growth of the H4 animals stopped at the age of 17 months , when the mortality started to become pronounced . It is concluded that housing conditions can modulate the outcome of the ageing of sedentary and otherwise not treated rats in long-term experiments . Further , the feasibility of monitoring body composition longitudinally with bioimpedance analysis was demonstrated The aim of the present study was to investigate the effects of glucocorticoids ( GCs ) on appetite and gene expression of the hypothalamic appetite regulatory peptides , neuropeptide Y ( NPY ) , agouti-related protein ( AGRP ) and cocaine and amphetamine-regulated transcript ( CART ) , in non-obese and obese rats . Both non-obese and obese rats were r and omly assigned to three groups : normal saline , low- and high-dose GC groups ( NSG , LDG and HDG , respectively ) , which received an intraperitoneal injection with normal saline ( 0.2 ml/100 g ) or hydrocortisone sodium succinate at 5 and 15 mg/kg , respectively , for 20 days . The expression levels of NPY , AGRP and CART mRNA in the hypothalamus were measured by real-time quantitative PCR . Non-obese and obese rats were found to undergo weight loss after GC injection , and a higher degree of weight loss was observed in the HDG rats . The average and cumulative food intakes in the obese and non-obese rats injected with high-dose GC were lower compared to that in the NSG ( p<0.05 ) . mRNA expression levels of the orexigenic neuropeptides , NPY and AGRP , and the anorexigenic neuropeptide , CART , were significantly lower in the HDG than levels in the NSG for both the obese and non-obese rats ( p<0.05 ) . GC treatment decreased appetite and body weight , induced apparent glucolipid metabolic disturbances and hyperinsulinemia , while down-regulated mRNA expression levels of the orexigenic neuropeptides , NPY and AGRP , and anorexigenic neuropeptide , CART , in the hypothalamus in the rats . The mechanism which induces this neuropeptide expression requires further study Background Systematic Review s ( SRs ) of experimental animal studies are not yet common practice , but awareness of the merits of conducting such SRs is steadily increasing . As animal intervention studies differ from r and omized clinical trials ( RCT ) in many aspects , the methodology for SRs of clinical trials needs to be adapted and optimized for animal intervention studies . The Cochrane Collaboration developed a Risk of Bias ( RoB ) tool to establish consistency and avoid discrepancies in assessing the method ological quality of RCTs . A similar initiative is warranted in the field of animal experimentation . Methods We provide an RoB tool for animal intervention studies ( SYRCLE ’s RoB tool ) . This tool is based on the Cochrane RoB tool and has been adjusted for aspects of bias that play a specific role in animal intervention studies . To enhance transparency and applicability , we formulated signalling questions to facilitate judgment . Results The result ing RoB tool for animal studies contains 10 entries . These entries are related to selection bias , performance bias , detection bias , attrition bias , reporting bias and other biases . Half these items are in agreement with the items in the Cochrane RoB tool . Most of the variations between the two tools are due to differences in design between RCTs and animal studies . Shortcomings in , or unfamiliarity with , specific aspects of experimental design of animal studies compared to clinical studies also play a role . Conclusions SYRCLE ’s RoB tool is an adapted version of the Cochrane RoB tool . Widespread adoption and implementation of this tool will facilitate and improve critical appraisal of evidence from animal studies . This may subsequently enhance the efficiency of translating animal research into clinical practice and increase awareness of the necessity of improving the method ological quality of animal studies Output:

Whilst housing did not affect body weight , both food intake and visceral adipose tissue mass were significantly higher in individually compared with socially housed animals . A combination of emotional stress and lack of social thermoregulation likely contributed to these effects .

MS2_1shot546

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The experience of pain arises from both physiological and psychological factors , including one 's beliefs and expectations . Thus , placebo treatments that have no intrinsic pharmacological effects may produce analgesia by altering expectations . However , controversy exists regarding whether placebos alter sensory pain transmission , pain affect , or simply produce compliance with the suggestions of investigators . In two functional magnetic resonance imaging ( fMRI ) experiments , we found that placebo analgesia was related to decreased brain activity in pain-sensitive brain regions , including the thalamus , insula , and anterior cingulate cortex , and was associated with increased activity during anticipation of pain in the prefrontal cortex , providing evidence that placebos alter the experience of pain Abstract Although individual differences in fear and anxiety modulate the pain response and may even cause more suffering than the initiating physical stimulus , little is known about the neural systems mediating this relationship . The present study provided the first examination of the neural correlates of individual differences in the tendency to ( 1 ) feel anxious about the potentially negative implication s of physical sensations , as measured by the anxiety sensitivity index ( ASI ) , and ( 2 ) fear various types of physical pain , as indexed by the fear of pain question naire ( FPQ ) . In separate sessions , participants completed these question naires and experienced alternating blocks of noxious thermal stimulation ( 45–50 ° C ) and neutral thermal stimulation ( 38 ° C ) during the collection of whole‐brain fMRI data . Regression analyses demonstrated that during the experience of pain , ASI scores predicted activation of a medial prefrontal region associated with self‐focused attention , whereas FPQ scores predicted activation of a ventral lateral frontal region associated with response regulation and anterior and posterior cingulate regions associated with monitoring and evaluation of affective responses . These functional relationships can not be wholly explained by generalized anxiety ( indexed by STAI‐T scores ) , which did not significantly correlate with activation of any regions . The present findings may help clarify both the impact of individual differences in emotion on the neural correlates of pain , and the roles in anxiety , fear , and pain processing played by medial and orbitofrontal systems The endogenous opioid system is involved in stress responses , in the regulation of the experience of pain , and in the action of analgesic opiate drugs . We examined the function of the opioid system and μ-opioid receptors in the brains of healthy human subjects undergoing sustained pain . Sustained pain induced the regional release of endogenous opioids interacting with μ-opioid receptors in a number of cortical and subcortical brain regions . The activation of the μ-opioid receptor system was associated with reductions in the sensory and affective ratings of the pain experience , with distinct neuroanatomical involvements . These data demonstrate the central role of the μ-opioid receptors and their endogenous lig and s in the regulation of sensory and affective components of the pain experience OBJECTIVE : The lack of a suitable disease-specific , health-related quality of life instrument for dyspepsia prompted the development of the Nepean Dyspepsia Index ( NDI ) . The utility of the NDI in functional dyspepsia is unknown . We aim ed to assess the validity of this new quality of life instrument for the first time in United States patients with documented functional dyspepsia . METHODS : The long form of the NDI contains a symptom index and 42 items design ed to measure impairment of subjects ’ ability to engage in and to enjoy relevant aspects of their life because of dyspepsia , as well as a ranking of the individual importance of each aspect . Patients ( n = 101 , mean age 51 yr , 62 % female ) who had a history of functional dyspepsia for ≥1 month and a negative endoscopy within the prior 1 yr were followed for 14 days . Patients completed the NDI and the vali date d Speilberger State-Trait Anxiety Inventory , Beck Depression Inventory , Short Form-36 , and a global assessment of symptoms and quality of life at baseline and 14 days later ; the NDI was also retested at 48 h and 2 wk . RESULTS : Five clinical ly relevant factors ( subscales ) , namely , tension/sleep , interference , eating/drinking , knowledge/control , and work/ study were identified by factor analysis , after incorporating individual importance ratings ( 25 items total ) . All subscales had excellent face validity and internal consistency ( Chronbach 's α , all > 0.85 ) . Reliability was also excellent ( intraclass correlations all > 0.84 ) . There were modest typically negative correlations between a number of the NDI subscales and the Short Form-36 , anxiety , and depression , indicating that the NDI is disease-specific and supporting its validity . Changes in NDI scales correlated moderately with global assessment of change ( total score r = −0.49 ) , indicating initial responsiveness . CONCLUSIONS : The Nepean Dyspepsia Index is a valid , disease-specific index for functional dyspepsia , measuring symptoms and health-related quality of life BACKGROUND & AIMS Hypersensitivity to proximal gastric distention as a result of abnormal central nervous system processing of visceral stimuli is a possible pathophysiologic mechanism in functional dyspepsia ( FD ) . Increasing evidence suggests involvement of both lateral and medial pain systems in normal visceral sensitivity and aberrant brain activation patterns in visceral hypersensitivity . We hypothesized that there is involvement of aberrant brain activation in FD with hypersensitivity to gastric distention . Our aim was to investigate regional cerebral blood flow during painful proximal gastric distention in hypersensitive FD . METHODS Brain (15)O-water positron emission tomography was performed in 13 FD patients with symptoms of gastric hypersensitivity during 3 conditions : no distention , sham distention , and isobaric distention to unpleasant or painful sensation . Pain , discomfort , nausea , and bloating during maximal distention were rated on visual analogue scales . Data were analyzed using statistical parametric mapping . RESULTS The threshold for painful distention was 6.6 + /- 3.8 mm Hg greater than the minimal distending pressure . At the corrected P level of less than .05 , subtraction analysis ( painful distention - no distention ) showed activations in bilateral gyrus pre central is , bilateral gyrus frontalis inferior , bilateral gyrus frontalis medialis , bilateral gyrus temporalis superior , bilateral cerebellar hemisphere , and left gyrus temporalis inferior . Sham distention minus no distention showed no activations . CONCLUSIONS Similar to healthy volunteers , proximal stomach distention in FD activates components of the lateral pain system and bilateral frontal inferior gyri , putatively involved in regulation of hunger and satiety . In hypersensitive FD , these activations occur at significantly lower distention pressures . In contrast to findings in normosensitivity , none of the components of the medial pain system were significantly activated & NA ; Irritable bowel syndrome ( IBS ) is one of the most common gastrointestinal illnesses and is characterized by altered visceral perception . Previous studies in IBS have failed to demonstrate altered somatic or cutaneous perception . The aims of the study were to determine whether IBS patients have visceral hypersensitivity and cutaneous heat‐induced hyperalgesia restricted to lumbosacral dermatomes , consistent with a localized segmental mechanism . Twelve patients ( ten women , two men ) with IBS and 17 control subjects ( 13 women , four men ) rated pain intensity and unpleasantness to distension of the rectum ( 35 , 55 mmHg ) and thermal stimulation ( 45 , 47 ° C ) of the h and and foot . Patients with IBS demonstrated cutaneous allodynia/hyperalgesia to thermal pain applied to the h and and foot . The cutaneous hyperalgesia was pronounced in the lower extremity yet present in the upper extremity to a lesser extent . Psychological testing revealed the IBS patients report more state anxiety and a greater number of somatic symptoms that significantly correlated with most of the pain measures . However , they did not differ from controls on several personality trait measures . These results suggest that patients with IBS have visceral hyperalgesia and cutaneous hyperalgesia that is distributed over a considerable rostral‐caudal distance yet optimally expressed in lumbosacral dermatomes . This distribution is consistent with patterns of spinal hyperexcitability observed in experimentally induced persistent pain conditions OBJECTIVES : Acupuncture is a commonly used therapy for treating functional dyspepsia ( FD ) , although the mechanism remains unclear . The objectives of this study were to investigate the differences in cerebral glycometabolism changes evoked by acupuncture and sham acupuncture and to explore the possible correlations between brain responses and clinical efficacy . METHODS : In all , 72 FD patients were r and omly assigned to receive either acupuncture or sham acupuncture treatment for 4 weeks . Ten patients in each group were r and omly selected for fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography scans to detect cerebral glycometabolism changes . The Nepean Dyspepsia Index ( NDI ) and Symptom Index of Dyspepsia ( SID ) were used to evaluate the therapeutic effect . RESULTS : ( i ) The clinical data showed that after treatment the decrease in SID score in the acupuncture group was significantly greater than that in the sham acupuncture group ( P<0.05 ) . The increase in NDI score between the two groups did not differ ( P>0.05 ) , and only the improvement in NDI score in the acupuncture group was clinical ly significant . ( ii ) The neuroimaging data indicated that after treatment the acupuncture group showed extensive deactivation in cerebral activities compared with the sham acupuncture group . In the acupuncture group , the deactivations of the brainstem , anterior cingulate cortex ( ACC ) , insula , thalamus , and hypothalamus were nearly all related to the decrease in SID score and the increase in NDI score ( P<0.05 , corrected ) . In the sham acupuncture group , the deactivations of the brainstem and thalamus tended to be associated with the increase in NDI score ( P<0.1 , corrected ) . CONCLUSIONS : Acupuncture and sham acupuncture have relatively different clinical efficacy and brain responses . Acupuncture treatment more significantly improves the symptoms and quality of life of FD patients . The more remarkable modulation on the homeostatic afferent network , including the insula , ACC , and hypothalamus , might be the specific mechanism of acupuncture It has been suggested that placebo analgesia involves both higher order cognitive networks and endogenous opioid systems . The rostral anterior cingulate cortex ( rACC ) and the brainstem are implicated in opioid analgesia , suggesting a similar role for these structures in placebo analgesia . Using positron emission tomography , we confirmed that both opioid and placebo analgesia are associated with increased activity in the rACC . We also observed a covariation between the activity in the rACC and the brainstem during both opioid and placebo analgesia , but not during the pain-only condition . These findings indicate a related neural mechanism in placebo and opioid analgesia & NA ; Visceral pain/discomfort is the cardinal complaints and treatment targets for functional gastrointestinal disorders ( FGID ) . However , effective treatment for such pain is limited and often associated with high placebo effects . The mechanisms of placebo effects in visceral pain are unclear . We used functional neuroimaging to study the central representations of the placebo effect and its anticipation during esophageal pain in healthy adults . Fourteen subjects were enrolled . Pain extent , psychophysical inventories [ Pain Catastrophizing Scale ( PAS ) , visual analogue scale ( VAS ) and short‐form McGill question naire ] , and brain activity upon placebo intervention and upon anticipation were assessed in response to esophageal balloon distension . Large reductions of pain extent , VAS rating , short‐form McGill question naire scores , and brain activity in the visceral pain matrix [ thalamus , somatosensory cortices , insula , prefrontal cortex ( PFC ) , anterior cingulate cortex ] were observed upon placebo treatment . The aforementioned brain areas and the bilateral amygdala were significantly correlated with decreased pain extent and VAS in response to placebo . The ventral lateral PFC ( VLPFC ) was associated with increased activity during anticipation of visceral pain . PAS can not predict the placebo effect in visceral pain . In conclusion , pronounced placebo analgesia was coupled with prominent changes of brain activity in visceral pain matrix , which are thus likely involved in high placebo efficacy during the treatment of visceral pain in FGID . VLPFC activation during the anticipation of placebo analgesia suggests top‐down control in the modulation of pain experience Output:

Changes were reported in several brain areas in FD patients including the frontal cortex , somatosensory cortex , insula , anterior cingulate cortex , thalamus , hippocampus , and amygdala . These brain activity changes were associated with visceral hypersensitivity , dyspeptic symptoms , poorer quality of life , anxiety , and depression . The results show that FD is associated with functional abnormalities in sensory and pain modulation , emotion , saliency , and homeostatic processing regions .

MS2_1shot547

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: We carried out a trial to evaluate the complication rate of intravesical ( LP ) versus extravesical ( Lich ) ureteroneocystostomy in recipients of renal transplantation . Ureteric stenosis was the predominant complication in the LP technique , which was more difficult to correct . Complications by the Lich technique were urinary leaks , which were managed successfully by prolonged bladder drainage . We conclude that the Lich technique is simpler to perform and avoids the complication of ureteric stenosis , and should therefore be the procedure of choice for ureteric implantation in recipients of renal transplants OBJECTIVE To determine whether the change from the Leadbetter-Politano technique to a stented extravesical technique for the vesico-ureteric anastomosis in renal transplantation has altered the incidence of urological complications . PATIENTS AND METHODS Data were retrieved from a prospect i ve computerized data base and by case-note review on 248 consecutive renal transplants performed between January 1990 and June 1996 . The characteristics of the donor . recipient and organ were noted , together with the technique used for the vesicoureteric anastomosis and the occurrence of major and minor urological complications . RESULTS The Leadbetter-Politano technique was used in 140 transplants and the stented extravesical technique in 108 . There were no significant differences in the donor , recipient or organ characteristics between the groups . The stented extravesical technique was associated with a significantly lower rate of major complications ( < 2 % ) and clinical ly significant haematuria than with the Leadbetter-Politano technique . CONCLUSION Changing from the Leadbetter-Politano technique to a stented extravesical technique for the vesico-ureteric anastomosis has been a major factor in reducing the incidence of urological complications in our transplant practice Abstract The incidence of urologic complications was studied in 131 patients with cadaver renal allografts allocated r and omly to undergo either the Politano-Leadbetter or end-to-side ureteroneocystostomy . Obstruction occurred in 6 per cent of patients with end-to-side versus 0 per cent of those with Politano-Leadbetter reconstructions ( p less than 0.05 ) . Complications of leakage , infection and graft loss were comparable in the 2 groups Output:

Based on our results , we conclude that there is evidence in favour of the extravesical ureteroneocystostomy for having a smaller amount of urological complications in kidney transplantation

MS2_1shot548

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: A new guar-containing wheatflake product was developed to assess its effect on carbohydrate tolerance in normal-weight , healthy subjects . The extruded wheatflake breakfast cereals containing 0 ( control ) or approximately 90 g guar gum/kg DM were fed to ten fasting , normal-weight , healthy subjects using a repeated measures design . The meals were similar in energy ( approximately 1.8 MJ ) , available carbohydrate ( 78 g ) , protein ( 15 g ) and fat ( 5.4 g ) content . The guar gum content of the test meals was 6.3 g. Venous blood sample s were taken fasting and at 15 , 30 , 45 , 60 , 90 , 120 , 150 and 240 min after commencing each breakfast and analysed for plasma glucose , insulin and C-peptide . The guar wheatflake meal produced a significant main effect for glucose and insulin at 0 - 60 min and 0 - 240 min time intervals respectively , but not for the C-peptide levels compared with the control meal . Significant reductions in postpr and ial glucose and insulin responses were seen following the guar wheatflake meal compared with the control meal at 15 and 60 min ( glucose ) and 15 , 60 , 90 and 120 min ( insulin ) . The 60 and 120 min areas under the curve for glucose and insulin were significantly reduced by the guar gum meal , as was the 240 min area under the curve for insulin . Thus , it can be concluded that the use of a severe method of heat extrusion to produce guar wheatflakes does not diminish the physiological activity of the guar gum The effects of an enzyme-hydrolyzed arabinoxylan from wheat ( AXOS ) versus an intact arabinoxylan from flax ( FLAX ) added to a ready-to-eat cereal ( RTEC ) on the postpr and ial appetitive , hormonal , and metabolic responses in overweight women ( BMI 25.0–29.9 kg/m2 ) were evaluated . Subsequent meal energy intake was also assessed . Two r and omized , double-blind , crossover design studies were completed . For trial 1 , the participants consumed the following RTEC breakfast , matched for total weight and varied in energy content : low-fiber ( LF , 4 g ) ; high-fiber ( HF , 15 g ) as either AXOS or FLAX . For trial 2 , the participants consumed LF , HF-AXOS , and HF-FLAX RTECs but also consumed another LF breakfast that was isocaloric ( LF-iso ) to that of the HF breakfasts . Perceived appetite and blood sample s ( trial 2 only ) were assessed before and after breakfast . An ad libitum lunch was offered 4 h post-breakfast . No differences in postpr and ial appetite responses were observed among any breakfasts in either trial . The HF-AXOS and HF-FLAX led to increased postpr and ial GLP-1 and peptide YY ( PYY ) concentrations vs. LF-iso . No differences were observed in lunch meal energy intake among breakfast meals in either trial . Collectively , these data suggest that 15 g of low molecular weight fiber added to RTECs did not affect perceived appetite or subsequent energy intake despite differences in satiety hormone signaling in overweight females Background — Among adults , skipping meals is associated with excess body weight , hypertension , insulin resistance , and elevated fasting lipid concentrations . However , it remains unknown whether specific eating habits regardless of dietary composition influence coronary heart disease ( CHD ) risk . The objective of this study was to prospect ively examine eating habits and risk of CHD . Methods and Results — Eating habits , including breakfast eating , were assessed in 1992 in 26 902 American men 45 to 82 years of age from the Health Professionals Follow-up Study who were free of cardiovascular disease and cancer . During 16 years of follow-up , 1527 incident CHD cases were diagnosed . Cox proportional hazards models were used to estimate relative risks and 95 % confidence intervals for CHD , adjusted for demographic , diet , lifestyle , and other CHD risk factors . Men who skipped breakfast had a 27 % higher risk of CHD compared with men who did not ( relative risk , 1.27 ; 95 % confidence interval , 1.06–1.53 ) . Compared with men who did not eat late at night , those who ate late at night had a 55 % higher CHD risk ( relative risk , 1.55 ; 95 % confidence interval , 1.05–2.29 ) . These associations were mediated by body mass index , hypertension , hypercholesterolemia , and diabetes mellitus . No association was observed between eating frequency ( times per day ) and risk of CHD . Conclusions — Eating breakfast was associated with significantly lower CHD risk in this cohort of male health professionals Objective : To test the hypothesis that a high carbohydrate breakfast with breakfast cereal leads to a meaningful reduction in dietary energy intake from fat , especially from saturated fat , and thus lower serum cholesterol levels . Design : An open r and omized controlled cross-over trial . The subjects were r and omized into intervention breakfast cereal or usual breakfast ( control ) groups . Setting : Free-living subjects aged 29–71 y in Eastern Finl and Subjects : 224 enrolled , 209 completed the study . The subjects were recruited from a survey of a r and om population sample and from other sources , and their serum cholesterol was not lower than 5.0 mmol/l . Recruited persons did not have any chronic disease or very low saturated fat intake . Intervention : The cereal group consumed 80 g ( men ) or 60 g ( women ) cereal at breakfast and the control group continued their usual dietary habits for six weeks . After a wash out of six weeks , a cross-over with another six week trial period took place . Measurements ( including serum sample s and a 3 d food record ) took place before and after the two trial periods . Results : The intervention period led to 2.5 en% ( energy percent units ) reduction in saturated fatty acids intake . The reduction in total fat intake was 5.5 en% . This was compensated for by increased intake of carbohydrates . The reduction in saturated fatty acids intake led to modest ( but in group 1 significant ) 0.15 mmol/l ( 2.5 % ) reduction in total serum cholesterol level . Conclusions : The trial showed that regular cereal breakfast can lead to reduced intake of total and saturated fatty acids of the daily diet and consequently to reduction in serum cholesterol level . Sponsorship : Supported by the Kellogg Company of Great Britain BACKGROUND Certain dietary components may play a role in the prevention of type 2 diabetes . OBJECTIVE We examined prospect ively the associations between whole- and refined-grain intake and the risk of type 2 diabetes in a large cohort of men . DESIGN Men from the Health Professionals Follow-up Study without a history of diabetes or cardiovascular disease in 1986 ( n = 42898 ) were followed for < /=12 y. Intakes of whole and refined grains , measured every 4 y by use of food-frequency question naires , were used to predict subsequent type 2 diabetes risk through multivariate analysis . RESULTS We ascertained 1197 cases of incident type 2 diabetes . After adjustment for age ; physical activity ; cigarette smoking ; alcohol consumption ; family history of diabetes ; and fruit , vegetable , and energy intakes , the relative risk of type 2 diabetes was 0.58 ( 95 % CI : 0.47 , 0.70 ; P for trend < 0.0001 ) comparing the highest with the lowest quintile of whole-grain intake . The association was moderately attenuated when additionally adjusted for body mass index ( relative risk : 0.70 ; 95 % CI : 0.57 , 0.85 ; P for trend = 0.0006 ) . Intake of refined grains was not significantly associated with risk of type 2 diabetes . After further adjustment for magnesium intake , cereal fiber intake , and glycemic load , the association between whole grains and type 2 diabetes was attenuated and the trend no longer significant . CONCLUSIONS In men , a diet high in whole grains is associated with a reduced risk of type 2 diabetes in men that may be mediated by cereal fiber . Efforts should be made to replace refined-grain with whole-grain foods Epidemiological studies have shown an inverse association between dietary intake of whole grains and the risk of chronic disease . This may be related to the ability to mediate a prebiotic modulation of gut microbiota . However , no studies have been conducted on the microbiota modulatory capability of whole-grain ( WG ) cereals . In the present study , the impact of WG wheat on the human intestinal microbiota compared to wheat bran ( WB ) was determined . A double-blind , r and omised , crossover study was carried out in thirty-one volunteers who were r and omised into two groups and consumed daily 48 g breakfast cereals , either WG or WB , in two 3-week study periods , separated by a 2-week washout period . Numbers of faecal bifidobacteria and lactobacilli ( the target genera for prebiotic intake ) , were significantly higher upon WG ingestion compared with WB . Ingestion of both breakfast cereals result ed in a significant increase in ferulic acid concentrations in blood but no discernible difference in faeces or urine . No significant differences in faecal SCFA , fasting blood glucose , insulin , total cholesterol ( TC ) , TAG or HDL-cholesterol were observed upon ingestion of WG compared with WB . However , a significant reduction in TC was observed in volunteers in the top quartile of TC concentrations upon ingestion of either cereal . No adverse intestinal symptoms were reported and WB ingestion increased stool frequency . Daily consumption of WG wheat exerted a pronounced prebiotic effect on the human gut microbiota composition . This prebiotic activity may contribute towards the beneficial physiological effects of WG wheat BACKGROUND The glycemic index ( GI ) of a food is thought to directly reflect the rate of digestion and entry of glucose into the systemic circulation . The blood glucose concentration , however , represents a balance of both the entry and the removal of glucose into and from the blood , respectively . Such direct quantification of the postpr and ial glucose curve with respect to interpreting the GI is lacking in the literature . OBJECTIVE We compared the plasma glucose kinetics of low- and high-GI breakfast cereals . DESIGN On 2 occasions , plasma insulin concentrations and plasma glucose kinetics ( by constant-rate infusion of [6,6-(2)H(2)]glucose ) were measured in 6 healthy males for 180 min after they fasted overnight and then consumed an amount of corn flakes ( CF ) or bran cereal ( BC ) containing 50 g available carbohydrate . RESULTS The GI of CF was more than twice that of BC ( 131.5 + /- 33.0 compared with 54.5 + /- 7.2 ; P < 0.05 ) , despite no significant differences in the rate of appearance of glucose into the plasma during the 180-min period . Postpr and ial hyperinsulinemia occurred earlier with BC than with CF , result ing in a 76 % higher plasma insulin concentration at 20 min ( 20.4 + /- 4.5 compared with 11.6 + /- 2.1 micro U/mL ; P < 0.05 ) . This was associated with a 31 % higher rate of disappearance of glucose with BC than with CF during the 30 - 60-min period ( 28.7 + /- 3.1 compared with 21.9 + /- 3.1 micro mol . kg(-)(1 ) . min(-)(1 ) ; P < 0.05 ) . CONCLUSION The lower GI of BC than of CF was not due to a lower rate of appearance of glucose but instead to an earlier postpr and ial hyperinsulinemia and an earlier increase in the rate of disappearance of glucose , which attenuated the increase in the plasma glucose concentration BACKGROUND High homocysteine and low B vitamin concentrations have been linked to the risk of vascular disease , stroke , and dementia and are relatively common in older adults . OBJECTIVE We assessed the effect of breakfast cereal fortified with folic acid , vitamin B-6 , and vitamin B-12 on vitamin and homocysteine status . DESIGN A r and omized , double-blind trial was conducted in 189 volunteers aged 50 - 85 y. The subjects had no history of hypertension , anemia , asthma , cancer , or cardiovascular or digestive disease and did not regularly consume multiple or B vitamin supplements or highly fortified breakfast cereal . Subjects were r and omly assigned to consume 1 cup ( 0.24 L ) breakfast cereal fortified with 440 microg folic acid , 1.8 mg vitamin B-6 , and 4.8 microg vitamin B-12 or placebo cereal for 12 wk . Blood was drawn at 0 , 2 , 12 , and 14 wk . Methionine-loading tests were conducted at baseline and week Output:

Consumption of RTEC is associated with a healthier dietary pattern , concerning intake of carbohydrates , dietary fiber , fat and micronutrients , however total sugar intake is higher . Persons consuming RTEC frequently ( ≥ 5 times/week ) have a lower risk of inadequate micronutrient intake especially for vitamin A , calcium , folate , vitamin B 6 , magnesium and zinc . Evidence from prospect i ve studies suggests that whole grain RTEC may have beneficial effects on hypertension and type 2 diabetes . Consumption of RTEC with soluble fiber helps to reduce LDL cholesterol in hypercholesterolemic men and RTEC fortified with folate can reduce plasma homocysteine . Consumption of RTEC , especially of fiber-rich or whole grain RTEC , is implicated with several beneficial nutritional and health outcomes . Of concern is the higher total sugar intake associated with frequent RTEC consumption

MS2_1shot549

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Aims /hypothesis . The amount and quality of fat in the diet could be of importance for development of insulin resistance and related metabolic disorders . Our aim was to determine whether a change in dietary fat quality alone could alter insulin action in humans . Methods . The KANWU study included 162 healthy subjects chosen at r and om to receive a controlled , isoenergetic diet for 3 months containing either a high proportion of saturated ( SAFA diet ) or monounsaturated ( MUFA diet ) fatty acids . Within each group there was a second assignment at r and om to supplements with fish oil ( 3.6 g n-3 fatty acids/d ) or placebo . Results . Insulin sensitivity was significantly impaired on the saturated fatty acid diet ( -10 % , p = 0.03 ) but did not change on the monounsaturated fatty acid diet ( + 2 % , NS ) ( p = 0.05 for difference between diets ) . Insulin secretion was not affected . The addition of n-3 fatty acids influenced neither insulin sensitivity nor insulin secretion . The favourable effects of substituting a monounsaturated fatty acid diet for a saturated fatty acid diet on insulin sensitivity were only seen at a total fat intake below median ( 37E % ) . Here , insulin sensitivity was 12.5 % lower and 8.8 % higher on the saturated fatty acid diet and monounsaturated fatty acid diet respectively ( p = 0.03 ) . Low density lipoprotein cholesterol ( LDL ) increased on the saturated fatty acid diet ( + 4.1 % , p < 0.01 ) but decreased on the monounsaturated fatty acid diet ( MUFA ) ( –5.2 , p < 0.001 ) , whereas lipoprotein ( a ) [ Lp(a ) ] increased on a monounsaturated fatty acid diet by 12 % ( p < 0.001 ) . Conclusions /interpretation . A change of the proportions of dietary fatty acids , decreasing saturated fatty acid and increasing monounsaturated fatty acid , improves insulin sensitivity but has no effect on insulin secretion . A beneficial impact of the fat quality on insulin sensitivity is not seen in individuals with a high fat intake ( > 37E % ) . [ Diabetologia ( 2001 ) 44 : 312–319 Meat contains numerous carcinogens , such as heterocyclic amines , polycyclic aromatic hydrocarbons , and N‐nitroso compounds , which can be derived either from natural food or during the process of food preparation . These carcinogens may increase pancreatic cancer risk . Furthermore , studies in animals showed that polyunsaturated fatty acids , especially linoleic acid , increase pancreatic cancer risk . We examined prospect ively the relation between pancreatic cancer risk and intake of fresh meat , processed meat , fish , eggs , total fat , and different types of fat . The Netherl and s Cohort Study consisted of 120,852 men and women who completed a baseline question naire in 1986 . After 13.3 years of follow‐up , 350 pancreatic cancer cases ( 66 % microscopically confirmed ) were available for analysis . A vali date d 150‐item food‐frequency question naire was used to calculate intake of fresh meat , processed meat , fish , eggs , fat and different types of fat . No association was found when examining the association between intake of fresh meat , other types of meat , fish , eggs , dietary intake of total fat and different types of fat and risk of pancreatic cancer . It is important for future studies to investigate the relation between different meat‐cooking methods and pancreatic cancer . © 2009 Case-control studies suggest that meat and cholesterol intakes may be related to elevated risks of pancreatic cancer . Few prospect i ve studies have examined associations between diet and pancreatic cancer , although in one recent study saturated fat consumption was related to higher risk . In a cohort of US women , the authors confirmed 178 pancreatic cancer cases over 18 years of follow-up . A mailed 61-item food frequency question naire was self-administered at baseline , and health and lifestyle variables were up date d biennially . Analyses were performed using Cox proportional hazards models to adjust for potential confounders . Intakes of total fat , different types of fats , and cholesterol were not associated with pancreatic cancer risk . Similarly , total meat , red meat , and dairy products were not related to risk . Individual food items contributing to intakes of total meat and dairy products , as well as fish and eggs , did not reveal any specific association . Updating dietary exposures by using question naires from 1980 , 1984 , 1986 , and 1990 produced similar findings . The authors ' data do not support previous findings that meat or saturated fat intakes are related to pancreatic cancer risk . Future prospect i ve studies should examine the influence of cooking practice s as well as other dietary habits on the risk of pancreatic cancer BACKGROUND Previous research relating dietary fat , a modifiable risk factor , to pancreatic cancer has been inconclusive . METHODS We prospect ively analyzed the association between intakes of fat , fat subtypes , and fat food sources and exocrine pancreatic cancer in the National Institutes of Health-AARP Diet and Health Study , a US cohort of 308 736 men and 216 737 women who completed a 124-item food frequency question naire in 1995 - 1996 . Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) were calculated using Cox proportional hazards regression models , with adjustment for energy intake , smoking history , body mass index , and diabetes . Statistical tests were two-sided . RESULTS Over an average follow-up of 6.3 years , 865 men and 472 women were diagnosed with exocrine pancreatic cancer ( 45.0 and 34.5 cases per 100 000 person-years , respectively ) . After multivariable adjustment and combination of data for men and women , pancreatic cancer risk was directly related to the intakes of total fat ( highest vs lowest quintile , 46.8 vs 33.2 cases per 100 000 person-years , HR = 1.23 , 95 % CI = 1.03 to 1.46 ; P(trend ) = .03 ) , saturated fat ( 51.5 vs 33.1 cases per 100 000 person-years , HR = 1.36 , 95 % CI = 1.14 to 1.62 ; P(trend ) < .001 ) , and monounsaturated fat ( 46.2 vs 32.9 cases per 100 000 person-years , HR = 1.22 , 95 % CI = 1.02 to 1.46 ; P(trend ) = .05 ) but not polyunsaturated fat . The associations were strongest for saturated fat from animal food sources ( 52.0 vs 32.2 cases per 100 000 person-years , HR = 1.43 , 95 % CI = 1.20 to 1.70 ; P(trend ) < .001 ) ; specifically , intakes from red meat and dairy products were both statistically significantly associated with increased pancreatic cancer risk ( HR = 1.27 and 1.19 , respectively ) . CONCLUSION In this large prospect i ve cohort with a wide range of intakes , dietary fat of animal origin was associated with increased pancreatic cancer risk A case-control study was conducted in the Minneapolis-St Paul ( Minnesota , United States ) area to assess the role of dietary factors in the etiology of pancreatic cancer . Cases were White males aged 40 to 84 whose death certificate listed pancreatic cancer ( exocrine only ) . White male controls were ascertained through r and om-digit dialing . Family members were interviewed about the subject 's dietary usage in the two years prior to death ( cases , n=212 ) or prior to interview ( controls , n=220 ) . Energy-adjusted , nutrient-intake , risk estimates were calculated . Among all respondents , negative trends were observed for polyunsaturated fat , linoleic acid , vitamin C , and β-carotene . Positive trends were observed for riboflavin and retinol . Point estimates were , in general , comparable between the analyses of all respondents and spouse-only respondents . The nutrients associated with a decreased risk for pancreatic cancer occur primarily in vegetables and fruits , of which the consumption of cruciferous and β-carotene-rich vegetables and citrus fruits provided the greatest reduction in risk To examine the relation between diet and pancreatic cancer , we conducted a population -based case-control study in western Washington . Cases ( n = 148 ) were married men , aged 20 - 74 years , who were diagnosed with pancreatic cancer from July 1982 to June 1986 . Controls ( n = 188 ) , identified by r and om digit dialing , were frequency matched to the cases by 5-year age groups . Wives responded as surrogates for both cases and controls . Wives were interviewed by telephone , and they completed a mailed , self-administered food frequency question naire . Results indicated that pancreatic cancer risk increased with increasing protein intake . The increased risk for heavy consumers of protein was largely confined to individuals aged 65 years and above . In that group , the odds ratio for those in the highest quartile of protein intake , relative to the lowest , was 6.0 ( 95 % confidence interval 1.7 - 20.6 ) . No association was found between pancreatic cancer risk and the intake of total fat , saturated fat , cholesterol , omega-3 fatty acids , or vitamins A and C. There was an unexpected inverse association between calcium intake and pancreatic cancer risk in these data . These findings are discussed in relation to possible etiologic mechanisms that they suggest Background Few epidemiologic studies have examined the role of nutrient intake in the development of pancreatic cancer in Japan . We addressed this association in a population -based case-control study . Methods The cases were 109 patients who were newly diagnosed with pancreatic cancer between January 2000 and March 2002 , and controls were selected by a r and om procedure from the general population . Data on dietary intake were collected by in-person interview , with the use of a food-frequency question naire . The risk of pancreatic cancer associated with nutrient intake was estimated by using the odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) derived from a conditional logistic model . Results A statistically positive trend in risk was observed with increasing cholesterol intake , with subjects in the highest tertile experiencing a two fold increased risk ( OR , 2.06 ; 95 % CI , 1.11–3.85 ; Ptrend = 0.02 ) . Vitamin C intake was negatively associated with risk of pancreatic cancer . The OR was 0.45 ( 95 % CI , 0.22–0.94 ) for subjects in the highest tertile compared to the lowest tertile ( Ptrend = 0.04 ) . Conclusions Our study indicates that high cholesterol intake is significantly associated with an increased risk of pancreatic cancer and that high vitamin C intake decreases the risk of pancreatic cancer BACKGROUND Meat intake has been associated with risk of exocrine pancreatic cancer , but previous findings have been inconsistent . This association has been attributed to both the fat and cholesterol content of meats and to food preparation methods . We analyzed data from the prospect i ve Multiethnic Cohort Study to investigate associations between intake of meat , other animal products , fat , and cholesterol and pancreatic cancer risk . METHODS During 7 years of follow-up , 482 incident pancreatic cancers occurred in 190,545 cohort members . Dietary intake was assessed using a quantitative food frequency question naire . Associations for foods and nutrients relative to total energy intake were determined by Cox proportional hazards models stratified by gender and time on study and adjusted for age , smoking status , history of diabetes mellitus and familial pancreatic cancer , ethnicity , and energy intake . Statistical tests were two-sided . RESULTS The strongest association was with processed meat ; those in the fifth quintile of daily intake ( g/1000 kcal ) had a 68 % increased risk compared with those in the lowest quintile ( relative risk = 1.68 , 95 % confidence interval = 1.35 to 2.07 ; Ptrend < .01 ) . The age-adjusted yearly incidence rates per 100,000 persons for the respective quintiles were 41.3 and 20.2 . Intakes of pork and of total red meat were both associated with 50 % increases in risk , comparing the highest with the lowest quintiles ( both Ptrend < .01 ) . There were no associations of pancreatic cancer risk with intake of poultry , fish , dairy products , eggs , total fat , saturated fat , or cholesterol . Intake of total and saturated fat from meat was associated with statistically significant increases in pancreatic cancer risk but that from dairy products was not . CONCLUSION Red and processed meat intakes were associated with an increased risk of pancreatic cancer . Fat and saturated fat are not likely to contribute to the underlying carcinogenic mechanism because the findings for fat from meat and dairy products differed . Carcinogenic substances related to meat preparation methods might be responsible for the positive association Although mounting evidence suggests that insulin resistance is involved in pancreatic carcinogenesis Output:

There was no evidence of publication bias or significant heterogeneity between subgroups on meta-regression analyses . The results of this meta- analysis do not support an independent association between diets high in total fat and pancreatic cancer risk

MS2_1shot550

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND / AIMS The effect of vitamin E administration on clinical and laboratory parameters of liver function and on markers of fibrogenesis was assessed in patients with mild to moderate alcoholic hepatitis in a double blind placebo controlled r and omized trial . METHODS Twenty-five patients received 1000 I.U. of vitamin E per day , while 26 patients received placebo for 3 months . The patients were followed for 1 year after entry into the trial . RESULTS Vitamin E did not result in significant greater decreases in serum aminotransferases and serum bilirubin or in greater increases in serum albumin as compared with placebo . Prothrombin time did not change , while serum creatinine remained in the normal range . Monocyte nuclear nuclear factor-kappa B binding activity decreased in patients who remained abstinent , regardless of whether they received vitamin E. As regards markers of hepatic fibrogenesis , vitamin E treatment decreased serum hyaluronic acid ( P<0.05 ) while serum aminoterminal peptide of type III procollagen did not change in either group . Four patients in the treatment group and five in the placebo group died during the 1-year study . CONCLUSIONS Vitamin E treatment improves serum hyaluronic acid but has no beneficial effects on tests of liver function in patients with mild to moderate alcoholic hepatitis BACKGROUND & AIMS Severe alcoholic hepatitis ( AH ) is a life-threatening disease for which adequate oral nutritional support is recommended . We performed a r and omized controlled trial to determine whether the combination of corticosteroid and intensive enteral nutrition therapy is more effective than corticosteroid therapy alone in patients with severe AH . METHODS We enrolled 136 heavy consumers of alcohol ( age , 18 - 75 y ) with recent onset of jaundice and biopsy-proven severe AH in our study , performed at 18 hospitals in Belgium and 2 in France , from February 2010 through February 2013 . Subjects were assigned r and omly ( 1:1 ) to groups that received either intensive enteral nutrition plus methylprednisolone or conventional nutrition plus methylprednisolone ( controls ) . In the intensive enteral nutrition group , enteral nutrition was given via feeding tube for 14 days . The primary end point was patient survival for 6 months . RESULTS In an intention-to-treat analysis , we found no significant difference between groups in 6-month cumulative mortality : 44.4 % of patients died in the intensive enteral nutrition group ( 95 % confidence interval [ CI ] , 32.2%-55.9 % ) and 52.1 % of controls died ( 95 % CI , 39.4%-63.4 % ) ( P = .406 ) . The enteral feeding tube was withdrawn prematurely from 48.5 % of patients , and serious adverse events considered to be related to enteral nutrition occurred in 5 patients . Regardless of group , a greater proportion of patients with a daily calorie intake less than 21.5 kcal/kg/day died ( 65.8 % ; 95 % CI , 48.8 - 78.4 ) than patients with a higher intake of calories ( 33.1 % ; 95 % CI , 23.1%-43.4 % ) ( P < .001 ) . CONCLUSIONS In a r and omized trial of patients with severe AH treated with corticosteroids , we found that intensive enteral nutrition was difficult to implement and did not increase survival . However , low daily energy intake was associated with greater mortality , so adequate nutritional intake should be a main goal for treatment . Clinical Trials.gov number : NCT01801332 BACKGROUND & AIMS An earlier pilot study from our liver unit suggested benefit from treatment with pentoxifylline ( PTX ) , an inhibitor of tumor necrosis factor ( TNF ) , in severe acute alcoholic hepatitis . The aim of the present study was to evaluate this treatment in a larger cohort of patients . METHODS One hundred one patients with severe alcoholic hepatitis ( Maddrey discriminant factor > or = 32 ) entered a 4-week double-blind r and omized trial of PTX ( 400 mg orally 3 times daily ) vs. placebo . Primary endpoints of the study were the effect of PTX on ( 1 ) short-term survival and ( 2 ) progression to hepatorenal syndrome . On r and omization , there were no differences in demographic and clinical characteristics or laboratory values ( including TNF ) between the 2 groups . RESULTS Twelve ( 24.5 % ) of the 49 patients who received PTX and 24 ( 46.1 % ) of the 52 patients who received placebo died during the index hospitalization ( P = 0.037 ; relative risk , 0.59 ; 95 % confidence interval , 0.35 - 0.97 ) . Hepatorenal syndrome was the cause of death in 6 ( 50 % ) and 22 ( 91.7 % ) patients ( P = 0.009 ; relative risk , 0.29 ; 95 % confidence interval , 0.13 - 0.65 ) . Three variables ( age , creatinine level on r and omization , and treatment with PTX ) were independently associated with survival . TNF values on r and omization were not predictive of survival ; however , during the study period they increased markedly in nonsurvivors compared with survivors in both groups . CONCLUSIONS Treatment with PTX improves short-term survival in patients with severe alcoholic hepatitis . The benefit appears to be related to a significant decrease in the risk of developing hepatorenal syndrome . Increasing TNF levels during the hospital course are associated with an increase in mortality rate UNLABELLED Steroids improve the outcome in alcoholic hepatitis ( AH ) , but up to 40 % of patients fail to respond adequately . Interleukin-2 ( IL-2 ) exacerbates steroid resistance in vitro . We performed a prospect i ve study to determine if intrinsic steroid sensitivity correlates with response to steroids in individuals with severe AH and if IL-2 receptor blockade can reverse this . Peripheral blood mononuclear cells ( P BMC s ) were isolated from 20 patients with AH and a Maddrey 's score > 32 . Patients were treated with oral prednisolone plus full supportive measures . Clinical resistance to oral steroid treatment was defined as a drop in serum bilirubin of < 25 % within 7 days or death within 6 months . In vitro steroid resistance was measured in P BMC using the dexamethasone suppression of lymphocyte proliferation assay and repeated after the addition of the anti-IL-2 receptor ( anti-CD25 ) monoclonal antibody , basiliximab . Suppression of lymphocyte proliferation < 60 % was considered to indicate steroid resistance . In all , 82 % ( 9/11 ) of in vitro steroid-resistant patients were dead at 6 months as compared to 21 % ( 2/9 ) of steroid-sensitive patients ( P = 0.03 ) . Similarly , 91 % ( 10/11 ) of in vitro steroid-resistant patients failed to show a significant fall in bilirubin at day 7 as compared to 44 % ( 4/9 ) of steroid-sensitive patients ( P < 0.05 ) . Basiliximab improved the maximal proliferation count in 91 % ( 10/11 ) of in vitro steroid-resistant patients ( P = 0.003 ) . CONCLUSION Clinical outcome of steroid therapy in this patient cohort correlated with in vitro steroid resistance . IL-2 blockade improved in vitro steroid sensitivity . This suggests that intrinsic lack of steroid sensitivity may contribute to poor clinical response to steroids in severe AH . IL-2 receptor blockade represents a possible mechanism to overcome this Chronic obstructive pulmonary disease ( COPD ) is a common , progressive respiratory disease that causes great morbidity and mortality despite treatment . Tumor necrosis factor alpha ( TNF-alpha ) plays a central role as a pro-inflammatory cytokine in COPD . TNF-alpha release is markedly inhibited by phosphodiesterase type 4 ( PDE4 ) inhibitors that have proven efficacious in COPD clinical trials . The aim of this study was to compare the in vitro activities of the novel selective PDE4 inhibitors CI-1044 compared to well-known PDE4 inhibitors , rolipram and cilomilast , and to the glucocorticoid dexamethasone at reducing lipopolysaccharide (LPS)-induced TNF-alpha release in whole blood from COPD patients and healthy subjects . In the whole blood from COPD patients pre-incubation with PDE4 inhibitors or dexamethasone result ed in a dose-dependent inhibition of LPS-induced TNF-alpha release with IC(50 ) values of 1.3+/-0.7 , 2.8+/-0.9 microM , higher to 10 microM and lesser than 0.03 microM for CI-1044 , rolipram , cilomilast and dexamethasone , respectively . We observed a similar inhibition in the whole blood from healthy volunteers with , however , higher IC(50 ) values . These results indicate that CI-1044 inhibits in vitro LPS-induced TNF-alpha release in whole blood from COPD patients better than rolipram and cilomilast and suggested that it could be a useful anti-inflammatory therapy in COPD Two hundred eighty-one alcoholic patients were prospect ively evaluated by clinical , biochemical , and histologic parameters during a 4-yr period to assess their prognosis . They were stratified into four categories of injury : 1 ) fatty liver ( 26 patients ) , 2 ) acute alcoholic hepatitis ( 106 ) , 3 ) cirrhosis ( 39 ) , and 4 ) cirrhosis with superimposed alcoholic hepatitis ( 111 ) . The rate of survival and variables correlating with survival varied according to the group . At 48 months , 70 % of the patients with fatty liver were alive , 58 % in the alcoholic hepatitis group , 49 % in cirrhosis , and 35 % in alcoholic hepatitis superimposed upon cirrhosis . Within group one , deaths were due to causes unrelated to liver disease . In the alcoholic hepatitis group , factors significantly correlating with survival were ascites , alanine amino-transferase levels , grams of alcohol consumed , continuation of alcohol intake , and clinical severity of disease . Survival in patients of group three correlated significantly with prothrombin time and histologic severity score . Patients with combined cirrhosis and alcoholic hepatitis exhibited the worst prognosis , with the most significant predictors of survival being age , grams of alcohol consumed , the ratio of serum aminotransferases ( AST : ALT ) and the histologic and clinical severity of the disease . Although a different pattern of correlates was observed for each pathologic level of injury , knowledge of the various correlates aids in prognostic assessment IMPORTANCE Prednisolone or pentoxifylline is recommended for severe alcoholic hepatitis , a life-threatening disease . The benefit of their combination is unknown . OBJECTIVE To determine whether the addition of pentoxifylline to prednisolone is more effective than prednisolone alone . DESIGN , SETTING , AND PARTICIPANTS Multicenter , r and omized , double-blind clinical trial conducted between December 2007 and March 2010 in 1 Belgian and 23 French hospitals of 270 patients aged 18 to 70 years who were heavy drinkers with severe biopsy-proven alcoholic hepatitis , as indicated by recent onset of jaundice in the prior 3 months and a Maddrey score of at least 32 . Duration of follow-up was 6 months . The last included patient completed the study in October 2010 . None of the patients were lost to follow-up for the main outcome . INTERVENTION Patients were r and omly assigned to receive either a combination of 40 mg of prednisolone once a day and 400 mg of pentoxifylline 3 times a day ( n=133 ) for 28 days , or 40 mg of prednisolone and matching placebo ( n=137 ) for 28 days . MAIN OUTCOMES AND MEASURES Six-month survival , with secondary end points of development of hepatorenal syndrome and response to therapy based on the Lille model , which defines treatment nonresponders after 7 days of initiation of treatment . RESULTS In intention-to-treat analysis , 6-month survival was not different in the pentoxifylline-prednisolone and placebo-prednisolone groups ( 69.9 % [ 95 % CI , 62.1%-77.7 % ] vs 69.2 % [ 95 % CI ; 61.4%-76.9 % ] , P = .91 ) , corresponding to 40 vs 42 deaths , respectively . In multivariable analysis , only the Lille model and the Model for End-Stage Liver Disease score were independently associated with 6-month survival . At 7 days , response to therapy assessed by the Lille model was not significantly different between the 2 groups ( Lille model score , 0.41 [ 95 % CI , 0.36 - 0.46 ] vs 0.40 [ 95 % CI , 0 Output:

Best Practice Advice 7 : Presence of systemic inflammatory response syndrome ( SIRS ) on admission is associated with an increased risk of multi‐organ failure ( MOF ) syndrome . Methylprednisolone does not improve survival beyond 28 days , and the benefits for < 28 days are modest .

MS2_1shot551

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This study examined the accuracy of insomnia patients and their treating physicians in rating whether an active hypnotic drug or a placebo was given in treatment . Forty older adults with primary insomnia were r and omly assigned to either an active ( temazepam ) or a placebo condition using a double-blind strategy . Ratings of treatment conditions were obtained at 1 week ( early treatment ) , 4 weeks ( midtreatment ) , and 8 weeks ( late treatment ) . Patients were able to accurately discriminate ( beyond chance levels ) between the active and placebo medications at the early ( 76.9 % accuracy ) and late treatment assessment timepoints ( 78.1 % accuracy ) , but not at midtreatment ( 51.5 % accuracy ) . Therapists , however , were able to make accurate discriminations at the late treatment assessment timepoint only ( 80 % accuracy ) ; early ( 69.2 % accuracy ) and midtreatment ( 47.2 % accuracy ) ratings did not exceed chance levels . Patients who had used hypnotic drugs prior to this trial were more accurate in their judgments of treatment conditions than those without prior exposure . The findings raise an important issue about the internal validity of the double-blind strategy , which may in fact be only a single-blind procedure & NA ; Patient , provider , and clinical investigator expectations concerning treatments are believed to play important roles in patient response . This study examined the association of patient and research nurse/physician pretreatment expectations of pain relief with actual pain relief , the accuracy of patient and research nurse guesses about patient medication assignment , and changes in research nurse and patient pain relief expectations over the course of a r and omized double‐blind trial of amitriptyline versus an active placebo for patients with chronic pain and spinal cord injuries ( SCI ) . Patient expectations of pain relief with amitriptyline were associated significantly with actual pain decrease for patients in the amitriptyline , but not placebo , condition . Research nurse/physician expectations did not predict patient pain relief . Both patients and the research nurse were able to guess patient medication assignment at a rate significantly greater than chance . The research nurse 's , but not the patients ’ , expectations of pain relief with amitriptyline decreased significantly over the course of the study . These findings have implication s for future r and omized controlled trials . Fully double‐blind conditions are very difficult to achieve , and it is informative to assess patient and research clinician expectations and guesses regarding medication assignment Background : In r and omised controlled trials , an increasingly used test of the ‘ blindness ’ of assessors is to have them guess the group to which each participant has been allocated . Because assessors are usually aware of the trial hypotheses , we predicted that trial participants who showed the greatest improvement would be assumed by an assessor to have been in the ‘ preferred intervention ’ group . Methods : Data were derived from a trial in recent-onset rheumatoid arthritis comparing cognitive behavioural therapy plus routine care with routine care alone . Results : Although in this trial assessor blindness was demonstrated , patients ‘ guessed ’ by the assessor to be in the cognitive therapy group showed significantly greater improvements than those predicted to have received routine care alone in variables predicted to change in the study protocol . Conclusions : These results indicate that even if an assessor ’s guesses about patient group allocations are more accurate than expected by chance , this would not necessarily demonstrate failure of blinding . This casts further doubt on the validity of forced choice paradigms in testing the integrity of blinding in clinical trials & NA ; Individual differences in pharmacokinetics and pharmacodynamics , the type of pain and the method of drug administration can account for the response variability to analgesics . By integrating a clinical and an experimental approach , we report here that another important source of variability is represented by individual differences in non‐specific ( placebo ) activation of endogenous opioid systems . In the first part of this study , we analyzed the effectiveness of buprenorphine , tramadol , ketorolac and metamizol in the clinical setting , where the placebo effect was completely eliminated by means of hidden infusions . We found that the hidden injections were significantly less effective and less variable compared with open injections ( in full view of the subject ) , suggesting that part of the response variability was due to non‐specific factors ( placebo ) . Since we could not administer the opioid antagonist , naloxone , to these patients , in the second part of this study , we induced experimental ischemic arm pain in healthy volunteers and found that , as occurred in clinical pain , the analgesic response to a hidden injection of the non‐opioid ketorolac was less effective and less variable than an open injection . Most importantly , we obtained the same effects by adding naloxone to an open injection of ketorolac , thus blocking the opioid‐mediated placebo component of analgesia . These findings indicate that both the psychological ( hidden injection ) and pharmacological ( naloxone ) blockade of the placebo response reduce the effectiveness of , and the response variability to , analgesic drugs . Therefore , an important source of response variability to analgesics appears to be due to differences in non‐specific activation of endogenous opioid systems In this report , the authors explore the relationships of perceived treatment to outcome in a large , placebo-controlled trial of nicotine replacement treatment for smoking reduction . In the original study ( J. F. Etter , E. Laszlo , J. P. Zellweger , C. Perrot , & T. V. Perneger , 2002 ) , which was conducted in French-speaking Switzerl and , smokers were r and omly assigned to receive nicotine , matching placebo products , or no intervention . At the end of the 6-month study , participants were asked to guess whether they had received nicotine or placebo . In the present analysis , the authors examined the difference in smoking reduction between those who believed they had received nicotine and those who believed they had received placebo . Regardless of actual treatment , smokers who believed they had received nicotine had significantly better outcome than those who believed they had received placebo CONTEXT This study was part of a large double-blind sham surgery-controlled trial design ed to determine the effectiveness of transplantation of human embryonic dopamine neurons into the brains of persons with advanced Parkinson 's disease . This portion of the study investigated the quality of life ( QOL ) of participants during the 1 year of double-blind follow-up . OBJECTIVES To determine whether QOL improved more in the transplant group than in the sham surgery group and to investigate outcomes at 1 year based on perceived treatment ( the type of surgery patients thought they received ) . DESIGN Participants were r and omly assigned to receive either the transplant or sham surgery . Reported results are from the 1-year double-blind period . SETTING Participants were recruited from across the United States and Canada . Assessment and surgery were conducted at 2 separate university medical centers . PARTICIPANTS A volunteer sample of 40 persons with idiopathic Parkinson 's disease participated in the transplant ( " parent " ) study , and 30 agreed to participate in the related QOL study : 12 received the transplant and 18 received sham surgery . INTERVENTIONS Interventions in the parent study were transplantation and sham brain surgery . Assessment s of QOL were made at baseline and 4 , 8 , and 12 months after surgery . MAIN OUTCOME MEASURES Comparison of the actual transplant and sham surgery groups and the perceived treatment groups on QOL and medical outcomes . We also investigated change over time . RESULTS There were 2 differences or changes over time in the transplant and sham surgery groups . Based on perceived treatment , or treatment patients thought they received , there were numerous differences and changes over time . In all cases , those who thought they received the transplant reported better scores . Blind ratings by medical staff showed similar results . CONCLUSIONS The placebo effect was very strong in this study , demonstrating the value of placebo-controlled surgical trials BACKGROUND Blinding can reduce bias in r and omized clinical trials , but blinding procedures may be unsuccessful . Our aim was to assess how often r and omized clinical trials test the success of blinding , the methods involved and how often blinding is reported as being successful . METHODS We analysed a r and om sample of blinded r and omized clinical trials indexed in the The Cochrane Central Register of Controlled Trials and published in 2001 . We identified 1599 blinded trials , and noted if they had conducted any test for the success of blinding . We also selected 200 trials r and omly that did not report any such test , and sent a question naire to the corresponding authors asking them if they had conducted any tests . RESULTS Thirty-one out of 1599 trials ( 2 % ) reported tests for the success of blinding . Test methods varied , and reporting was generally incomplete . Blinding was considered successful in 14 out of the 31 trials ( 45 % ) and unclear in 10 ( 32 % ) . Of the seven trials ( 23 % ) reporting unsuccessful blinding the risk of a biased trial result was either not addressed or was discounted in six cases . We received 130 question naires from trial authors ( 65 % ) of which 15 ( 12 % ) informed that they had conducted , but not published , tests . CONCLUSIONS Blinding is rarely tested . Test methods vary , and the reporting of tests , and test results , is incomplete . There is a considerable method ological uncertainty how best to assess blinding , and an urgent need for improved methodology and improved reporting Psychopharmacological studies usually attempt to eliminate " nonspecific " influences on outcome by double-blind design s. In a r and omized , double-blind comparison of alprazolam , imipramine , and placebo , the great majority of panic disorder patients ( N = 59 ) and their physicians were able to rate accurately whether active drug or placebo had been given . Moreover , physicians could distinguish between the two types of active drugs . Inasmuch as correct rating was possible halfway through treatment , concerns about the internal validity of the double-blind strategy arise This purpose of this article is to contrast the analgesic efficacy of acupuncture following dental surgery with the analgesic effects based on the expectation of benefit in two independently conducted placebo-controlled trials evaluating acupuncture as an adjunctive therapy for dental surgery . Both trials used pain following dental surgery as the outcome variable , and both included a blinding check to ascertain patients ’ beliefs regarding which treatment they were receiving . Although no statistically significant analgesic effect was observed between the acupuncture and placebo groups , participants in both experiments who believed they received real acupuncture reported significantly less pain than patients who believed that they received a placebo . Patients ’ beliefs regarding the receipt of acupuncture bore a stronger relationship to pain than any specific action possessed by acupuncture . These results also support the importance of both employing credible controls for the placebo effect in clinical trials and evaluating the credibility of those controls Heading Abstract Rationale . Critics have called into question findings from double-blind placebo-controlled studies because subjects are given drug administration instructions informing them of a placebo condition . The assertion that these drug administration instructions bias estimates of effectiveness has undergone surprisingly little empirical investigation . Objectives . The primary objective of this study was to determine whether drug administration instructions informing subjects of a placebo condition affect the drug response and affect the saliva concentration of the stimulant . Methods . We assessed caffeine responses and levels of saliva concentration of caffeine in 52 subjects who were r and omly assigned to receive one of two drug administration instructions : ( a ) placebo-informed instructions ( i.e. , individuals informed of the placebo ) analogous to those used in double-blind studies and ( b ) placebo-uninformed instructions ( i.e. , individuals informed they are taking an active stimulant ) . Results . On most measures ( systolic blood pressure , heart rate , h and steadiness , reaction time , fatigue , and tension ) , drug administration instructions did not significantly influence caffeine response . Instructions also had no significant effect on saliva concentration of caffeine . However , only individuals who were uninformed of the placebo condition showed significant diastolic blood pressure and vigor increases with 125 mg caffeine , and significant h and steadiness impairment and vigor increases with 325 mg caffeine compared to placebo . Conclusions . These overall findings suggest that a limited bias is introduced by drug administration instructions . The results do not support any suggestion that information about the existence of a placebo condition dramatically influences conclusions drawn about drug responses in placebo-controlled trials The objective of this study was to assess whether nicotine replacement therapy , administered in a real-life situation , could reduce cigarette consumption in smokers who were not prepared to quit smoking . Daily smokers of more than 20 cigarettes per day who had no intention to quit smoking in the next 6 months were recruited from the general population and r and omly assigned to either a 6-month treatment of nicotine ( choice among a 15-mg nicotine patch , a 4-mg nicotine gum , a 10-mg nicotine inhaler , or a combination of these , N = 265 ) , matching placebo products ( N = 269 ) , or no intervention ( N = 389 ) . Products were sent to participants by mail . Education was limited to a booklet . Of 923 participants , 879 ( 95 % ) were followed up after 6 months . Mean baseline consumption was 30 cigarettes per day in all groups . At 6 months , cigarette consumption decreased by a median of 10 cigarettes per day in the nicotine group , 7.5 in the placebo group , and 2.5 among controls ( p < 0.04 for all pair-wise comparisons ) . Smoking cessation rates were low ( 2%–4 % ) and did not differ significantly between groups . Quit attempts were less frequent among controls ( 21 % ) than among the nicotine ( 28 % , p = 0.04 ) and placebo ( 27 % , p = 0.08 ) subjects . In conclusion , nicotine replacement therapy helped smokers reduce their cigarette consumption and maintain this reduction over 6 months , but a large part of this reduction was attributable to a placebo effect Output:

First , when blinding fails research es can not determine whether any observed improvement in the group receiving active treatment result ed because of the treatment ’s effect or because of participants ’ expectancies . Second , participant expectancies could create ceiling effects if there are strong placebo effects in each treatment arm and this may falsely suggest that the active treatment is ineffective without expectancy . Third , the knowledge that a participant will be allocated active treatment or placebo in double-blind placebo-controlled RCTs is likely to lead to weaker treatment responses than would be expected in st and ard clinical practice , in which patients are unlikely to doubt that they have been given an active treatment . Conclusions Participants ’ expectancies can undermine the validity of double-blind placebo-controlled RCTs .

MS2_1shot552

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : Cancer patients experience many physical and psychosocial problems for which they need support . WebChoice is an Internet-based , interactive health communication application that allows cancer patients to monitor their symptoms and problems , provides individually tailored information and self-management support , e-communication with expert cancer nurses , and an e-forum for group discussion with other patients . Objective : The objective of this study was to examine the effects of WebChoice on symptom distress ( primary outcome ) , depression , self-efficacy , health-related quality of life , and social support ( secondary outcomes ) . Methods : In this 1-year repeated- measures r and omized controlled trial , 325 breast and prostate cancer patients were r and omized into 1 experimental group with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites . Results : Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale ( slope estimate , −0.052 [ 95 % confidence interval , −0.101 to −0.004 ] ; t = 4.42 ; P = .037 ) . There were no significant group differences on secondary outcomes . Additional analyses showed significant within-group improvements in depression in the experimental group only . In the control group , self-efficacy and health-related quality of life deteriorated significantly over time . Conclusion : This r and omized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms . Although only 1 hypothesis was partially supported , the combined results show a clear trend toward better scores in the intervention group on most outcome measures . Implication s for Practice : If findings can be supported with additional research , WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness Abstract OBJECTIVE : Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer , with particular emphasis on assisting the underserved . DESIGN : R and omized controlled trial conducted between 1995 and 1998 . SETTING : Five sites : two teaching hospitals ( Madison , Wis , and Chicago , Ill ) , two nonteaching hospitals ( Chicago , Ill ) , and a cancer re source center ( Indianapolis , Ind ) . The latter three sites treat many underserved patients . PARTICIPANTS : Newly diagnosed breast cancer patients ( N=246 ) under age 60 . INTERVENTIONS : Experimental group received Comprehensive Health Enhancement Support System ( CHESS ) , a home-based computer system providing information , decision-making , and emotional support . MEASUREMENTS AND MAIN RESULTS : Pretest and two posttest surveys ( at two- and five-month follow-up ) measured aspects of participation in care , social/information support , and quality of life . At two-month follow-up , the CHESS group was significantly more competent at seeking information , more comfortable participating in care , and had greater confidence in doctor(s ) . At five-month follow-up , the CHESS group had significantly better social support and also greater information competence . In addition , experimental assignment interacted with several indicators of medical underservice ( race , education , and lack of insurance ) , such that CHESS benefits were greater for the disadvantaged than the advantaged group . CONCLUSIONS : Computer-based patient support systems such as CHESS may benefit patients by providing information and social support , and increasing their participation in health care . These benefits may be largest for currently underserved population CONTEXT Rapid increases in access to the Internet have made it a viable mode for public health intervention . No controlled studies have evaluated this re source for weight loss . OBJECTIVE To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site . DESIGN R and omized , controlled trial conducted from April to December 1999 . SETTING AND PARTICIPANTS Ninety-one healthy , overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2 ) . Analyses were performed for the 65 who had complete follow-up data . INTERVENTIONS Participants were r and omly assigned to a 6-month weight loss program of either Internet education ( education ; n = 32 with complete data ) or Internet behavior therapy ( behavior therapy ; n = 33 with complete data ) . All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss re sources . Participants in the behavior therapy group received additional behavioral procedures , including a sequence of 24 weekly behavioral lessons via e-mail , weekly online su bmi ssion of self-monitoring diaries with individualized therapist feedback via e-mail , and an online bulletin board . MAIN OUTCOME MEASURES Body weight and waist circumference , measured at 0 , 3 , and 6 months , compared the 2 intervention groups . RESULTS Repeated- measures analyses showed that the behavior therapy group lost more weight than the education group ( P = .005 ) . The behavior therapy group lost a mean ( SD ) of 4.0 ( 2.8 ) kg by 3 months and 4.1 ( 4.5 ) kg by 6 months . Weight loss in the education group was 1.7 ( 2.7 ) kg at 3 months and 1.6 ( 3.3 ) kg by 6 months . More participants in the behavior therapy than education group achieved the 5 % weight loss goal ( 45 % vs 22 % ; P = .05 ) by 6 months . Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months ( P = .001 ) and 6 months ( P = .005 ) . CONCLUSIONS Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites . Thus , the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs Purpose Patients undergoing radiotherapy for prostate cancer suffer from a variety of symptoms which influence health-related quality of life . We have developed an application ( Interaktor ) for smartphones and tablets for early detection , reporting and management of symptoms , and concerns during treatment for prostate cancer . The study evaluates the effect on symptom burden and quality of life when using the application for real-time symptom assessment and management during radiotherapy for localized prostate cancer . Methods A non-r and omized controlled study was used at two university hospitals in Sweden where 64 patients constituted a control group and 66 patients made up an intervention group . The intervention group was asked to report symptoms via the application daily during the treatment as well as 3 weeks after . The EORTC QLQ-C30 and its module PR25 and the Sense of Coherence question naire were administered at three time points in both groups . Results The intervention group rated significantly lower levels of fatigue and nausea at the end of radiotherapy . Moreover , they had significantly less burden in emotional functioning , insomnia , and urinary-related symptoms at the end of treatment as well as 3 months later compared with the control group . In the multivariate analyses , with education and sense of coherence as covariates , the intervention group still significantly rated emotional functioning ( p = 0.007 ) , insomnia ( p = 0.017 ) , and urinary-related symptoms ( p = 0.008 ) as better than the control group at T2 . ConclusionS tudy findings suggest that Interaktor could be an efficient mHealth tool for facilitating supportive care needs during cancer treatment PURPOSE Early breast cancer survivors ( BCSs ) report high unmet care needs , and easily accessible care is not routinely available for this growing population . The Breast Cancer E-Health ( BREATH ) trial is a Web-based self-management intervention to support the psychological adjustment of women after primary treatment , by reducing distress and improving empowerment . PATIENTS AND METHODS This multicenter , r and omized , controlled , parallel-group trial evaluated whether care as usual ( CAU ) plus BREATH is superior to CAU alone . BREATH is delivered in sixteen fully automated weekly modules covering early survivorship issues . Two to 4 months post-treatment , BCSs were r and omly assigned to receive CAU + BREATH ( n = 70 ) or CAU alone ( n = 80 ) using a stratified block design ( ratio 1:1 ) . Primary outcomes were distress ( Symptom Checklist-90 ) and empowerment ( Cancer Empowerment Question naire ) , assessed before r and om assignment ( baseline , T0 ) and after 4 ( T1 ) , 6 ( T2 ) , and 10 months ( T3 ) of follow-up . Statistical ( analysis of covariance ) and clinical effects ( reliable change index ) were tested in an intention-to-treat analysis ( T0 to T1 ) . Follow-up effects ( T0 to T3 ) were assessed in assessment completers . RESULTS CAU + BREATH participants reported significantly less distress than CAU-alone participants ( -7.79 ; 95 % CI , -14.31 to -1.27 ; P = .02 ) with a small-to-medium effect size ( d = 0.33 ) , but empowerment was not affected ( -1.71 ; 95 % CI , 5.20 to -1.79 ; P = .34 ) . More CAU + BREATH participants ( 39 of 70 [ 56 % ] ; 95 % CI , 44.1 to 66.8 ) than CAU-alone participants ( 32 of 80 [ 40 % ] ; 95 % CI , 30.0 to 51.0 ) showed clinical ly significant improvement ( P = .03 ) . This clinical effect was most prominent in low-distress BCSs . Secondary outcomes confirmed primary outcomes . There were no between-group differences in primary outcomes during follow-up . CONCLUSION Access to BREATH reduced distress among BCSs , but this effect was not sustained during follow-up Background Physical activity ( PA ) behavior change interventions among cancer survivors have used face-to-face , telephone , email , and print-based methods . However , computer-tailored , Internet-delivered programs may be a more viable option to achieve PA behavior change . Objective The objective of this study is to test the feasibility and preliminary efficacy of a Web-based PA behavior change program among cancer survivors . Methods Nova Scotian cancer survivors ( N=415 ) who previously expressed interest in a research study were approached . Interested participants were asked to complete an online assessment of PA and quality of life ( QOL ) before being r and omized to either a theory-based PA behavior change program using the PA tracking website UWALK ( UCAN ; n=48 ) or usual care ( UC ; n=47 ) . After the intervention ( 9 weeks ) , participants completed another online assessment of PA and QOL as well as measures to evaluate the program and website . Descriptive analyses from surveys and Web analytic software were used to assess feasibility and mean change scores were used to test efficacy . Results Of all contacted survivors , 95 ( 22.3 % , 95/415 ) completed baseline measures and were r and omized with 84 ( 88 % , 84/95 ) completing the 9-week assessment . The behavior change program and website were rated highly on the satisfaction items . Average logins were 10.3 ( 1.1 per week ) and 26.0 % ( 111/432 ) of the weekly modules were completed . Most participants ( 71 % , 29/41 ) indicated they were more aware of their daily PA levels and 68 % ( 28/41 ) found the site easily navigable . Adjusted group differences in total exercise minutes favored the UCAN group by an increase of 42 minutes ( 95 % CI -65 to 150 ; P=.44 , d=0.17 ) . Results were more pronounced , though still nonsignificant , among those not meeting guidelines at baseline where UCAN increased PA by 52 minutes compared to a decrease of 15 minutes in UC ( adjusted between group difference=75 , 95 % CI -95 to 244 ; P=.38 , d=0.27 ) . Conclusions We found that Internet-delivery may be a feasible alternative to more costly methods to promote PA among Nova Scotian cancer survivors . Moreover , there was a trend toward increased PA among those in the UCAN group , especially among those who were not meeting PA guidelines at baseline . Future research should focus on recruiting inactive cancer survivors and engaging them in the website to determine the optimal potential of Web-based interventions for promoting PA in cancer survivors Background Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer . While oral chemotherapy includes benefits such as ease of administration , convenience , and minimization of invasive infusions , patients receive less oversight , support , and symptom monitoring from clinicians . Additionally , adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens . With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology , we created a mobile health intervention for medication and symptom management . Objective The objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer . Methods We used a 5-step development model to create a comprehensive mobile app with theoretically informed content . The research and technical development team worked together to develop and iteratively test the app . In addition to the research team , key stakeholders including patients and family members , oncology clinicians , health care representatives , and practice administrators contributed to the content refinement of the intervention . Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the r and omized controlled trial . Results We incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing . App components included medication reminders , self-reporting of medication adherence and symptoms , an education Output:

Results from the studies showed a high level of engagement . Self-efficacy , psychological symptoms , and quality of life were the most commonly assessed psychosocial variables . The present review showed that despite the heterogeneity in the studies assessed and inconsistent results , DI may constitute an excellent means to help cancer patients and survivors cope better with the disease and with treatment side effects , as they can improve self-management and wellbeing .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Introduction Globally , HIV-related stigma is prevalent in healthcare setting s and is a major barrier to HIV prevention and treatment adherence . Some intervention studies have showed encouraging outcomes , but a gap continues to exist between what is known and what is actually delivered in medical setting s to reduce HIV-related stigma . Methods This article describes the process of implementing a stigma reduction intervention trial that involved 1760 service providers in 40 hospitals in China . Guided by Diffusion of Innovation theory , the intervention identified and trained about 15–20 % providers as popular opinion leaders ( POLs ) to disseminate stigma reduction messages in each intervention hospital . The intervention also engaged governmental support in the provision of universal pre caution supplies to all participating hospitals in the trial . The frequency of message diffusion and reception , perceived improvement in universal pre caution practice s and reduction in the level of stigma in hospitals were measured at 6- and 12-month follow-up assessment s. Results Within the intervention hospitals , POL providers reported more frequent discussion s with their co-workers regarding universal pre caution principles , equal treatment of patients , provider-patient relationships and reducing HIV-related stigma . Service providers in the intervention hospitals reported more desirable intervention outcomes than providers in the control hospitals . Our evaluation revealed that the POL model is compatible with the target population , and that the unique intervention entry point of enhancing universal pre caution and occupational safety was the key to improved acceptance by service providers . The involvement of health authorities in supporting occupational safety was an important element for sustainability . Conclusions This report focuses on explaining the elements of our intervention rather than its outcomes . Lessons learned from the intervention implementation will enrich the development of future programs that integrate this or other intervention models into routine medical practice , with the aim of reducing HIV-related stigma and improving HIV testing , treatment and care in medical setting People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy . Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness This study assessed the effect of a brief intervention aim ed at reducing HIV-related stigma among service providers in China . From December 2005 to June 2006 , 138 service providers from four county hospitals in the Yunnan province of China were r and omly assigned into either an intervention or a control condition . HIV stigma reduction concepts were conveyed through participatory small group activities , including role-plays , games , group discussion s , and testimony by an HIV advocate . Participants were assessed at baseline before the intervention , and at 3- and 6-month follow-ups . Data were analyzed using a logistic regression mixed-effects model . Service providers in the brief intervention condition were significantly more likely to report better protection of patients ' confidentiality and right to HIV testing , lower levels of negative feelings toward people living with HIV/AIDS , and more accurate underst and ing and practice of universal pre caution s. This brief intervention pilot showed potential in reducing HIV stigma and discrimination among service providers in China . Further intervention trials are needed to test the efficacy and long-term outcomes of this intervention HIV infection is increasingly prevalent in adolescents , and primary prevention programmes have been most effective when based on existing theories , including social cognitive theory ( SCT ) . Nurses play an important role in assessing adolescents ' risk for HIV infection and in recommending preventive behaviour change , if their comfort with these activities is increased . Practising nurses ( n = 88 , mean age = 40.8 ) from a university medical centre and surrounding hospitals participated in either a didactic or SCT-based workshop and a vignette-based assessment . Utilizing a r and omized controlled design , this study compared the effectiveness of the two types of workshops by measuring HIV-related knowledge and attitudes , as well as comfort with and intent to perform HIV-related risk assessment s. Differences in comfort and intent based on target patients ' cultural descriptors were also evaluated . The SCT-based workshops yielded more positive results for all four outcome variables at the 8-week follow-up ( F2,71 = 4.27 , P < 0.02 ) . Cultural stereotyping also appeared to play a role in nurses ' intent to perform assessment s ( F2,74 = 11.81 , P < 0.001 ) . Suggestions for improving the workshops and incorporating other theory-based approaches are discussed BACKGROUND The st and ardized patient approach has proved to be an effective training tool for medical educators . This article explains the process of employing st and ardized patients in an HIV stigma reduction intervention in healthcare setting s in China . METHODS The study was conducted in 40 hospitals in two provinces of China . One year after the stigma reduction intervention , st and ardized patients made unannounced visits to participating hospitals , r and omly approached service providers on duty and presented symptoms related to HIV and disclosed HIV-positive test results . After each visit , the st and ardized patients evaluated their providers ' attitudes and behaviours using a structured checklist . St and ardized patients also took open-ended observation notes about their experience and the evaluation process . RESULTS Seven st and ardized patients conducted a total of 217 assessment s ( 108 from 20 hospitals in the intervention condition ; 109 from 20 hospitals in the control condition ) . Based on a comparative analysis , the intervention hospitals received a better rating than the control hospitals in terms of general impression and universal pre caution compliance as well as a lower score on stigmatizing attitudes and behaviours toward the st and ardized patients . CONCLUSION St and ardized patients are a useful supplement to traditional self-report assessment s , particularly for measuring intervention outcomes that are sensitive or prone to social desirability The aim of the study was to improve health workers ' skills and confidence in dealing with patients with HIV disease and increase attention to patients ' human rights . A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management , health education , and attitudinal change toward patients with HIV disease . The intervention group n=1072 , control group n=480 . Following initial question naire-defining focus groups , nurses , laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training . Data were collected in all sites pre-training and 1 y later . Hierarchical multiple regression analysis controlling for baseline data , and orthogonal factor analysis to define scales were used . Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment , attitudes and beliefs about people with HIV disease , less fear and more sympathy for and responsibility toward HIV patients , and an increase in self-perceived clinical skills . There was increased willingness to treat and teach colleagues about people with HIV . Clinician fear and discrimination were significantly reduced , and the climate of fear that was associated with HIV was replaced with a professional concern . There was increased underst and ing of appropriate psychosocial , clinical and human rights issues associated with HIV treatment and prevention . This intervention , targeting health workers in an entire state and using HIV/AIDS information , role modeling , diffusion of training and discussion s of discrimination and human rights , significantly affected the perception of risk groups and behaviors , perceived skills in treatment and counseling , reduced fears and increased concern for people with HIV disease , and improved the climate of treatment and prevention of HIV disease compared with a control state & NA ; We tested the impacts of a professionally assisted peer‐group intervention on Chilean health workers ' HIV‐related knowledge , attitudes , and behaviors using a quasi‐experimental design with a pretest and 3‐month posttest . Two Santiago suburbs were r and omly assigned to the intervention or delayed intervention control condition . Five community clinics per suburb participated . Interested workers at the intervention ( n = 262 ) and control ( n = 293 ) clinics participated and completed both evaluations . At posttest , intervention clinic workers had higher knowledge and more positive attitudes regarding HIV , condoms , stigmatization , and self‐efficacy for prevention . They reported more partner discussion about safer sex , less unprotected sex , and more involvement in HIV prevention activities in the clinic and the community , but they did not report fewer sexual partners or more st and ard pre caution s behaviors . Because of these positive impacts , the program will become a regular continuing education unit that can be used to meet health‐worker licensing requirements Objective To evaluate an AIDS education intervention for health workers in Metro Manila hospitals . Methods A r and omized controlled education program consisting of lectures , role-plays , posters and pamphlets was delivered to physicians , nurses , laboratory technologists and orderlies in Manila hospitals . Knowledge , attitudes and infection control practice s were measured before , immediately after , and 2 months after the intervention . Results Baseline survey among 641 hospital workers revealed poor knowledge , negative attitudes towards AIDS patients , and inappropriate infection control practice s. Immediately after the intervention , there was significant improvement in ( 1 ) knowledge scores ( 8.7–11.2 in the intervention group versus 8.5–9.5 in the control group ; range , 0–14 ) , ( 2 ) attitude scores ( 54.4–60.6 versus 54.6–56.8 ; range , 22–88 ) , and ( 3 ) needle-recapping practice s ( 14–43 % versus 39–43 % ) ( all P values < 0.001 ) . After 2 months , attitude scores in the experimental group fell to the same level as those of the control group , while improvements in knowledge and needle recapping were largely maintained . Role-playing was considered by the participants to be the most effective component of the intervention . Conclusions These results suggest that AIDS training for hospital workers in the Philippines and in similar countries is necessary and can be effective . Ideally , such training should include role-playing and should be ongoing in order to sustain the effect OBJECTIVES The objective of the intervention was to reduce service providers ' stigmatizing attitudes and behaviors toward people living with HIV . METHODS The r and omized controlled trial was conducted in 40 county-level hospitals in 2 provinces of China between October 2008 and February 2010 . Forty-four service providers were r and omly selected from each hospital , yielding a total of 1760 study participants . We r and omized the hospitals to either an intervention condition or a control condition . In the intervention hospitals , about 15 % of the popular opinion leaders were identified and trained to disseminate stigma reduction messages . RESULTS We observed significant improvements for the intervention group in reducing prejudicial attitudes ( P < .001 ) , reducing avoidance intent towards people living with HIV ( P < .001 ) , and increasing institutional support in the hospitals ( P = .003 ) at 6 months after controlling for service providers ' background factors and clinic-level characteristics . The intervention effects were sustained and strengthened at 12 months . CONCLUSIONS The intervention reduced stigmatizing attitudes and behaviors among service providers . It has the potential to be integrated into the health care systems in China and other countries In response to a Department of Health , Engl and , circular encouraging policies of named voluntary antenatal HIV antibody testing , one West Midl and s health authority in Engl and introduced a policy of raising the issue proactively at the first antenatal attendance . In order to facilitate this policy a short staff education programme was provided for midwives . This paper reports on part of a study which aim ed to evaluate the impact of the HIV awareness training programme . A sample of midwives ( n = 65 ) was r and omly selected for inclusion in the study . Thirty-three had attended training and 32 had not . Data were collected using a self-administered question naire exploring knowledge of aetiology of HIV/AIDS , knowledge of transmission , knowledge of obstetric and paediatric HIV , attitudes to HIV , issues related to antenatal HIV antibody testing and opinions about the HIV awareness training programme . Results indicated no significant difference in levels of knowledge or in attitude between those who had attended the training programme and those who had not . Similarly , no significant difference was found in terms of how midwives would react to women requesting HIV antibody testing . Many of the results contradict the current literature and as a conclusion it is suggested that there is a need to review HIV-related training for midwives This study compared the effectiveness of an AIDS knowledge-only program Output:

Conclusions Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal pre caution . Very low quality evidence indicates that professionally-assisted peer group interventions , modular interactive training , participatory self-guided assessment and intervention , contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma .

MS2_1shot554

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Quality of life ( QoL ) is one of the most significant issues in prostate cancer treatment decisions . This study aim ed to investigate the toxicity of hypofractionated stereotactic radiotherapy ( SBRT ) and QoL after treatment in localized prostate cancer patients . Material s and methods A prospect i ve single-center clinical study was performed in low- and intermediate-risk prostate cancer patients . Patients received 33.5 Gy in 5 fractions ( SHARP regimen ) . Acute and late toxicity was assessed according to RTOG/EORTC score . Patients filled out EORTC QLQ-C30 and prostate cancer-specific QLQ-PR25 question naires . Results The analysis included 68 prostate cancer patients ( 55–83 years , median 73 ) with clinical stage T1c-T2cN0M0 , median combined Gleason score of 6 ( 3–8 ) , and median prostate-specific antigen ( PSA ) level of 10 ng/mL ( 4–20 ng/mL ) . Neoadjuvant and rogen deprivation therapy was given to 52 patients ( 76.5 % ) , and stopped in 31 patients ( 45.5 % ) after 6 months ; in 21 patients ( 31 % ) after 2–3 years . Average and median follow-up was 24 months ( 18–45 ) . Median nadir PSA level was 0.03 ng/mL for all patients and 0.6 ng/mL for patients without hormone treatment . No patients had PSA failure . There were no acute grade IV toxicities . One patient ( 1.5 % ) developed grade III and 24 patients ( 35.3 % ) grade II acute bladder toxicity . No one developed grade III and 7 patients ( 10.3 % ) grade II acute rectal toxicity . No grade III or IV late gastrointestinal or genitourinary toxicities were reported . Grade II late urinary symptoms were observed in 8 patients ( 11.8 % ) and gastrointestinal symptoms in 3 patients ( 4.4 % ) . Global health status/QoL was good and improved during the observational period . ConclusionS BRT for prostate cancer patients is a well-tolerated treatment in terms of toxicity and QoL , has no negative impact on functioning and everyday life , with the important benefit of a short treatment period . However , long-term follow-up data are needed . ZusammenfassungHintergrundDie Lebensqualität ( QoL ) ist zu einem der wichtigsten Schwerpunkte bei der Wahl der Prostatakarzinombeh and lung geworden . Das Thema dieser Studie war die Untersuchung der Toxizität der hypofraktionierten stereotaktischen Radiotherapie ( SBRT ) und der QoL nach Beh and lung des lokal begrenzten Prostatakarzinoms . Material ien und Method enDie prospektive , monozentrische , klinische Studie wurde bei Prostatakarzinompatienten mit niedrigem bis mittlerem Risiko durchgeführt . Die Patienten erhielten 33,5 Gy in 5 Fraktionen ( SHARP-Beh and lungsschema ) . Akute und späte Toxizität wurden nach den Kriterien des RTOG/EORTC-Scores klassifiziert . Die Patienten füllten das EORTC-QLQ-C30- und das prostatakarzinomspezifische QLQ-PR25-Formular aus . ErgebnisseDie Analyse umfasste 68 Prostatakarzinompatienten ( medianes Alter 73 , Spanne 55–83 Jahre ) i m klinischen Staging T1c – T2cN0M0 , mit einem medianen Gleason-Score von 6 ( Spanne 3–8 ) und einem medianen PSA-Wert ( prostataspezifisches Antigen ) von 10 ng/ml ( Spanne 4–20 ng/ml ) . Eine neoadjuvante And rogendeprivationstherapie erhielten 52 Patienten ( 76,5 % ) ; die Hormontherapie beendet 31 Patienten ( 45,5 % ) nach 6 Monaten und 21 Patienten ( 31 % ) nach 2–3 Jahren . Das durchschnittliche und mediane Follow-up dauerte 24 Monate ( Spanne 18–45 ) . Der mediane PSA-Nadir betrug 0,03 ng/ml für alle Patienten und 0,6 ng/ml für Patienten ohne Hormontherapie . PSA-Versagen und akute Grad-IV-Toxizitäten traten nicht auf . Ein Patient ( 1,5 % ) hatte eine Grad-III- und 24 Patienten ( 35,3 % ) eine Grad-II-Harnblasentoxizität , kein Patient eine Grad-III- und 7 Patienten ( 10,3 % ) eine akute Grad-II-Rektumtoxizität . Späte gastrointestinale oder urogenitale Toxizitäten III . oder IV . Grade s wurden nicht berichtet . Bei 8 Patienten ( 11,8 % ) traten späte Miktionsbeschwerden II . Grade s und bei 3 Patienten ( 4,4 % ) gastrointestinale Symptome auf . Globaler Gesundheitsstatus/QoL war gut und besserte sich in der untersuchten Zeit . SchlussfolgerungSBRT ist beim Prostatakarzinom eine gut tolerierte Beh and lung hinsichtlich Toxizität und QoL , ohne negativen Einfluss auf das Alltagsleben und dem wichtigen Vorteil einer kurzen Beh and lungszeit . Langfristige Follow-up-Untersuchungen müssen noch folgen PURPOSE To report the short-term clinical outcomes and acute and late treatment-related genitourinary ( GU ) and gastrointestinal ( GI ) toxicities in patients with intermediate- and high-risk prostate cancer treated with dose-escalated stereotactic body radiation therapy ( SBRT ) . METHODS AND MATERIAL S Between 2011 and 2014 , 24 patients with prostate cancer were treated with SBRT to the prostate gl and and proximal seminal vesicles . A high-dose avoidance zone ( HDAZ ) was created by a 3-mm expansion around the rectum , urethra , and bladder . Patients were treated to a minimum dose of 36.25 Gy in 5 fractions , with a simultaneous dose escalation to a dose of 50 Gy to the target volume away from the HDAZ . Acute and late GU and GI toxicity outcomes were measured according to the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale , version 4 . RESULTS The median follow-up was 25 months ( range , 18 - 45 months ) . Nine patients ( 38 % ) experienced an acute grade 2 GU toxicity , which was medically managed , and no patients experienced an acute grade 2 GI toxicity . Two patients ( 8 % ) experienced late grade 2 GU toxicity , and 2 patients ( 8 % ) experienced late grade 2 GI toxicity . No acute or late grade ≥3 GU or GI toxicities were observed . The 24-month prostate-specific antigen relapse-free survival outcome for all patients was 95.8 % ( 95 % confidence interval 75.6%-99.4 % ) , and both biochemical failures occurred in patients with high-risk disease . All patients are currently alive at the time of this analysis and continue to be followed . CONCLUSIONS A heterogeneous prostate SBRT planning technique with differential treatment volumes ( low dose : 36.25 Gy ; and high dose : 50 Gy ) with an HDAZ provides a safe method of dose escalation . Favorable rates of biochemical control and acceptably low rates of acute and long-term GU and GI toxicity can be achieved in patients with intermediate- and high-risk prostate cancer treated with SBRT Summary Background Prostate cancer might have high radiation-fraction sensitivity that would give a therapeutic advantage to hypofractionated treatment . We present a pre-planned analysis of the efficacy and side-effects of a r and omised trial comparing conventional and hypofractionated radiotherapy after 5 years follow-up . Methods CHHiP is a r and omised , phase 3 , non-inferiority trial that recruited men with localised prostate cancer ( pT1b – T3aN0M0 ) . Patients were r and omly assigned ( 1:1:1 ) to conventional ( 74 Gy delivered in 37 fractions over 7·4 weeks ) or one of two hypofractionated schedules ( 60 Gy in 20 fractions over 4 weeks or 57 Gy in 19 fractions over 3·8 weeks ) all delivered with intensity-modulated techniques . Most patients were given radiotherapy with 3–6 months of neoadjuvant and concurrent and rogen suppression . R and omisation was by computer-generated r and om permuted blocks , stratified by National Comprehensive Cancer Network ( NCCN ) risk group and radiotherapy treatment centre , and treatment allocation was not masked . The primary endpoint was time to biochemical or clinical failure ; the critical hazard ratio ( HR ) for non-inferiority was 1·208 . Analysis was by intention to treat . Long-term follow-up continues . The CHHiP trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N97182923 . Findings Between Oct 18 , 2002 , and June 17 , 2011 , 3216 men were enrolled from 71 centres and r and omly assigned ( 74 Gy group , 1065 patients ; 60 Gy group , 1074 patients ; 57 Gy group , 1077 patients ) . Median follow-up was 62·4 months ( IQR 53·9–77·0 ) . The proportion of patients who were biochemical or clinical failure free at 5 years was 88·3 % ( 95 % CI 86·0–90·2 ) in the 74 Gy group , 90·6 % ( 88·5–92·3 ) in the 60 Gy group , and 85·9 % ( 83·4–88·0 ) in the 57 Gy group . 60 Gy was non-inferior to 74 Gy ( HR 0·84 [ 90 % CI 0·68–1·03 ] , pNI=0·0018 ) but non-inferiority could not be cl aim ed for 57 Gy compared with 74 Gy ( HR 1·20 [ 0·99–1·46 ] , pNI=0·48 ) . Long-term side-effects were similar in the hypofractionated groups compared with the conventional group . There were no significant differences in either the proportion or cumulative incidence of side-effects 5 years after treatment using three clinician-reported as well as patient-reported outcome measures . The estimated cumulative 5 year incidence of Radiation Therapy Oncology Group ( RTOG ) grade 2 or worse bowel and bladder adverse events was 13·7 % ( 111 events ) and 9·1 % ( 66 events ) in the 74 Gy group , 11·9 % ( 105 events ) and 11·7 % ( 88 events ) in the 60 Gy group , 11·3 % ( 95 events ) and 6·6 % ( 57 events ) in the 57 Gy group , respectively . No treatment-related deaths were reported . Interpretation Hypofractionated radiotherapy using 60 Gy in 20 fractions is non-inferior to conventional fractionation using 74 Gy in 37 fractions and is recommended as a new st and ard of care for external-beam radiotherapy of localised prostate cancer . Funding Cancer Research UK , Department of Health , and the National Institute for Health Research Cancer Research Network BACKGROUND Studies have reported a low α/β ratio for prostate cancer , suggesting that hypofractionation could enhance the biological tumour dose without increasing genitourinary and gastrointestinal toxicity . In the multicentre phase 3 , HYpofractionated irradiation for PROstate cancer ( HYPRO ) trial , hypofractionated radiotherapy was compared with conventionally fractionated radiotherapy for treatment of prostate cancer . We have previously reported acute and late incidence of genitourinary and gastrointestinal toxicity ; here we report protocol -defined 5-year relapse-free survival outcomes . METHODS We did an open-label , r and omised , phase 3 trial at seven Dutch radiotherapy centres . We enrolled patients with intermediate-risk to high-risk T1b-T4NX-N0MX-M0 localised prostate cancer , a prostate-specific antigen concentration of 60 μg/L or less , and a WHO performance status of 0 - 2 . We used a web-based application to r and omly assign ( 1:1 ) patients to either hypofractionated radiotherapy of 64·6 Gy ( 19 fractions of 3·4 Gy , three fractions per week ) or conventionally fractionated radiotherapy of 78·0 Gy ( 39 fractions of 2·0 Gy , five fractions per week ) . Based on an estimated α/β ratio for prostate cancer of 1·5 Gy , the equivalent total dose in fractions of 2·0 Gy was 90·4 Gy for hypofractionation compared with 78·0 Gy for conventional fractionation . The primary endpoint was relapse-free survival . All analyses were done on an intention-to-treat basis in all eligible patients . The HYPRO trial completed recruitment in 2010 and follow-up is ongoing . This trial is registered with IS RCT N , number IS RCT N85138529 . FINDINGS Between March Output:

Conclusions : Despite the lack of long-term follow-up and heterogeneity of the available evidence , prostate SBRT affords appropriate biochemical control with few high- grade toxicities .

MS2_1shot555

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES The aim of these two studies was to evaluate the effectiveness of the Mindful Self-Compassion ( MSC ) program , an 8-week workshop design ed to train people to be more self-compassionate . METHODS Study 1 was a pilot study that examined change scores in self-compassion , mindfulness , and various wellbeing outcomes among community adults ( N = 21 ; mean [ M ] age = 51.26 , 95 % female ) . Study 2 was a r and omized controlled trial that compared a treatment group ( N = 25 ; M age = 51.21 ; 78 % female ) with a waitlist control group ( N = 27 ; M age = 49.11 ; 82 % female ) . RESULTS Study 1 found significant pre/post gains in self-compassion , mindfulness , and various wellbeing outcomes . Study 2 found that compared with the control group , intervention participants reported significantly larger increases in self-compassion , mindfulness , and wellbeing . Gains were maintained at 6-month and 1-year follow-ups . CONCLUSIONS The MSC program appears to be effective at enhancing self-compassion , mindfulness , and wellbeing The mechanisms underlying the association between positive emotions and physical health remain a mystery . We hypothesize that an upward-spiral dynamic continually reinforces the tie between positive emotions and physical health and that this spiral is mediated by people ’s perceptions of their positive social connections . We tested this overarching hypothesis in a longitudinal field experiment in which participants were r and omly assigned to an intervention group that self-generated positive emotions via loving-kindness meditation or to a waiting-list control group . Participants in the intervention group increased in positive emotions relative to those in the control group , an effect moderated by baseline vagal tone , a proxy index of physical health . Increased positive emotions , in turn , produced increases in vagal tone , an effect mediated by increased perceptions of social connections . This experimental evidence identifies one mechanism — perceptions of social connections — through which positive emotions build physical health , indexed as vagal tone . Results suggest that positive emotions , positive social connections , and physical health influence one another in a self-sustaining upward-spiral dynamic OBJECTIVE To present and determine the impact of the Mindfulness-Based Program for Infertility ( MBPI ) . DESIGN Controlled clinical trial . SETTING University research unit . PATIENT(S ) Fifty-five infertile women completed the MBPI , and 37 infertile women were assigned to a control group . INTERVENTION(S ) The MBPI includes 10 weekly sessions , in a group format , with a duration of about 2 hours each ( men attend three sessions ) . MAIN OUTCOME MEASURE(S ) St and ardized measures of depression , state anxiety , entrapment , defeat , internal and external shame , experiential avoidance , mindfulness , self-compassion , and infertility self-efficacy were endorsed pre- and post-MBPI . RESULT ( S ) The MBPI group and the control group were shown to be equivalent at baseline . By the end of the MBPI , women who attended the program revealed a significant decrease in depressive symptoms , internal and external shame , entrapment , and defeat . Inversely , they presented statistically significant improvement in mindfulness skills and self-efficacy to deal with infertility . Women in the control group did not present significant changes in any of the psychological measures , except for a decrease in self-judgment . CONCLUSION ( S ) Increasing mindfulness and acceptance skills , as well as cognitive decentering from thoughts and feelings , seem to help women to experience negative inner states in new ways , decreasing their entanglement with them and thus their psychological distress . Data suggest that the MBPI is an effective psychological intervention for women experiencing infertility OBJECTIVE To determine whether cognitive behavior therapy ( CBT ) , which we had shown in a previous study to restore ovarian function in women with functional hypothalamic amenorrhea ( FHA ) , could also ameliorate hypercortisolemia and improve other neuroendocrine and metabolic concomitants of in FHA . DESIGN R and omized controlled trial . SETTING Clinical research center at an academic medical university . PATIENT(S ) Seventeen women with FHA were r and omized either to CBT or observation . INTERVENTION(S ) CBT versus observation . MAIN OUTCOME MEASURE(S ) Circulatory concentrations of cortisol , leptin , thyroid-stimulating hormone ( TSH ) , total and free thyronine ( T(3 ) ) , and total and free thyroxine ( T(4 ) ) before and immediately after completion of CBT or observation . ( Each woman served as her own control . ) RESULT ( S ) Cognitive behavior therapy but not observation reduced cortisol levels in women with FHA . There were no changes in cortisol , leptin , TSH , T(3 ) , or T(4 ) levels in women r and omized to observation . Women treated with CBT showed increased levels of leptin and TSH , but their levels of T(3 ) and T(4 ) remained unchanged . CONCLUSION ( S ) In women with FHA , CBT ameliorated hypercortisolism and improved the neuroendocrine and metabolic concomitants of FHA while observation did not . We conclude that a cognitive , nonpharmacologic approach aim ed at alleviating problematic attitudes not only can restore ovarian activity but also improve neuroendocrine and metabolic function in women with FHA . CLINICAL TRIAL REGISTRATION NUMBER NCT01674426 BACKGROUND This study explores the differences in prenatal maternal expectations , coping re sources and maternal stress between first time mothers of IVF twins and first time mothers of spontaneously conceived twins . The role of prenatal maternal expectations in the prediction of maternal stress was examined , as well as the mediating and moderating effect of coping re sources on the association between pregnancy-type group and maternal stress . METHOD Mothers of twins from various regions in Israel were included in this prospect i ve and cross-sectional study in which 88 mothers of IVF-conceived twins and 98 mothers of spontaneously conceived twins were interviewed twice . First , at 33 - 36 weeks of their pregnancy they completed a socio-demographic question naire and the maternal expectations question naire ; then at 6 months after birth they completed a question naire regarding the delivery and medical condition of the infants , and their coping re sources and maternal stress . RESULTS Compared with mothers who conceived spontaneously , IVF mothers had more positive prenatal maternal expectations , but poorer coping re sources and higher levels of maternal stress 6 months after birth . Maternal expectations had no predictive power regarding maternal stress , although the mother 's coping re sources were significantly related to maternal stress and mediated the association between pregnancy type and maternal stress . CONCLUSIONS IVF-pregnant women bearing twins should be considered a high-risk group . Early identification of these mothers is essential for timely psychosocial interventions in order to enhance their re sources and decrease maternal stress . Further longitudinal studies are required to determine causality in more ethnically-diverse mothers of twins This study examined the correlation between various coping strategies and sexual functioning and the likelihood of conception from in vitro fertilization ( IVF ) . Self-reported question naires were distributed r and omly among the 102 women enrolled in an IVF program , 96 of whom were recruited . Of the studied parameters , positive reinterpretation , and growth , and active coping strategies were found to be positively associated with sexual functioning , while there was a significantly ( p < .05 ) adverse influence of planning and self-restraint . Being sexually active during the IVF-treatment period was found to be positively associated ( p < .05 ) with the likelihood of conception and with adaptive coping strategies Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health . Prospect i ve studies , which control for baseline health status , consistently show increased risk of death among persons with a low quantity , and sometimes low quality , of social relationships . Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes . The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored BACKGROUND IVF treatment involves a re assessment of issues concerning autonomy and relatedness . This study aims to extend prior studies on the psychological impact of IVF/ICSI by study ing the association between the personality dimensions of Self-Criticism and Dependency with the psychological well-being and quality of the couple relationship for women starting their first IVF treatment . METHODS This is a cross-sectional study of 68 women starting their first IVF treatment at the Leuven University Fertility Centre of the University of Leuven , Belgium . All women were administered vali date d self-report measures assessing Self-Criticism and Dependency , negative life events , psychological well-being , relationship satisfaction , and relationship and sexual concerns . Pearson 's correlation coefficients were calculated between all study variables , followed by four separate hierarchical multiple regression analyses for psychological well-being , relationship satisfaction , and relationship and sexual concerns . RESULTS High Self-Criticism was negatively associated with psychological well-being ( r = -0.63 , P < 0.001 ) and relationship satisfaction ( r = -0.29 , P < 0.05 ) , and positively associated with relationship ( r = 0.39 , P < 0.01 ) and sexual ( r = 0.37 , P < 0.01 ) concerns . High Dependency was negatively associated with psychological well-being ( r = -0.30 , P < 0.05 ) , not significantly associated with relationship satisfaction and relationship concerns , and positively related to sexual concerns ( r = 0.31 , P < 0.05 ) . CONCLUSIONS This cross-sectional study suggests that the personality dimensions of Self-Criticism and Dependency may enhance our underst and ing of the psychological well-being and quality of the couple relationship of women starting their first IVF treatment . However , further prospect i ve research on this topic is needed BACKGROUND The aim of this study was to gain more insight into long-term psychological adjustment to IVF in women . METHODS In a prospect i ve cohort study , 298 women entering their first IVF treatment cycle ( including ICSI ) completed st and ardized psychological question naires before the start of the treatment , just after the last treatment cycle , and 6 months and 3 - 5 years after the last treatment cycle . The main outcome measures were state anxiety , depression and mode of adaptation to unsuccessful IVF . RESULTS Anxiety and depression were found at follow-up to return to baseline levels following treatment not result ing in a live birth , after an initial increase during treatment . On the contrary , treatment result ing in a live birth was found to lead to a more positive long-term emotional status . Women who focused on new life goals as a mode of adaptation 3 - 5 years after IVF without a live birth showed lower levels of anxiety and depression compared with those who persisted in their attempts to get pregnant . CONCLUSIONS Treatment that result ed in a live birth led to more positive emotional adjustment . In addition , most women who did not give birth to a child after treatment adjusted well psychologically . Positive adjustment was related to developing new life goals rather than persisting in attempts to get pregnant . Helping women to change life goals after ab and oning treatment might have beneficial effects on the adaptation process Objective : In an earlier study , positive emotional style ( PES ) was associated with resistance to the common cold and a bias to underreport ( relative to objective disease markers ) symptom severity . This work did not control for social and cognitive factors closely associated with PES . We replicate the original study using a different virus and controls for these alternative explanations . Methods : One hundred ninety-three healthy volunteers ages 21 to 55 years were assessed for a PES characterized by being happy , lively , and calm ; a negative emotional style ( NES ) characterized by being anxious , hostile , and depressed ; other cognitive and social dispositions ; and self-reported health . Subsequently , they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms . Results : For both viruses , increased PES was associated with lower risk of developing an upper respiratory illness as defined by objective criteria ( adjusted odds ratio comparing lowest with highest tertile = 2.9 ) and with reporting fewer symptoms than expected from concurrent objective markers of illness . These associations were independent of prechallenge virus-specific antibody , virus type , age , sex , education , race , body mass , season , and NES . They were also independent of optimism , extraversion , mastery , self-esteem , purpose , and self-reported health . Conclusions : We replicated the prospect i ve association of PES and colds and PES and biased symptom reporting , extended those results to infection with an influenza virus , and “ ruled out ” alternative hypotheses . These results indicate that PES may play a more important role in health than previously thought . BMI = body mass index ; CI = confidence interval ; NES = negative emotional style ; PES = positive emotional style ; RV = rhinovirus ; TCID = Tissue Culture Infectious Dose Research ers have documented the consequences of both expressing and suppressing emotion using between-subjects design s. It may be argued , however , that successful adaptation depends not so much on any one regulatory process , but on the ability to flexibly enhance or suppress emotional expression in accord with situational dem and s. We tested this hypothesis among New York City college students in the aftermath of the September 11th terrorist attacks . Subjects ' performance in a laboratory task in which they enhanced emotional expression , suppressed emotional expression , and behaved normally on different trials was examined as a prospect i ve predictor of their adjustment across the first two years of college . Results supported the flexibility hypothesis . A regression analysis controlling for initial distress and motivation and cognitive re sources found that subjects who were better Output:

Neuroticism and the use of escapist coping strategies were positively associated with distress by multiple studies . Social support was negatively associated with distress by several studies . There is a paucity of research using positive emotional outcome measures ( e.g. well-being , positive affect , happiness or life satisfaction ) to quantify emotional adjustment . Whilst some psychosocial variables appear to be consistently associated with distress for IVF patients , two-thirds of the variables tested to date do not appear to be associated with emotional adjustment .

MS2_1shot556

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The prophylactic administration of injectable tilmicosin for pneumonia in weaned beef calves was investigated in 1,806 animals . Comparisons were made among calves receiving an " on-arrival " injection of tilmicosin , calves receiving a single injection of long-acting oxytetracycline , and calves receiving no prophylaxis . Morbidity and mortality attributable to pneumonia , morbidity and mortality attributable to all causes , and case fatality were significantly lower in the group of calves that received tilmicosin , compared with calves that received long-acting oxytetracycline and calves that received no prophylactic antibiotic . Mean time to initial pneumonia treatment was significantly extended in calves that received prophylaxis , compared with those that received no antibiotic on arrival at the feedlot . Calves that received tilmicosin gained significantly more weight than calves that received oxytetracycline . Calves that were not treated for pneumonia during the trial period gained significantly more weight than did those calves that were treated for pneumonia regardless of experimental group . The majority of mortalities were attributable to fibrinous pneumonia ( 31/34 ) . Important bacterial isolates ( Pasteurella spp , Haemophilus somnus , Actinomyces pyogenes ) obtained at necropsy did not have resistance to tilmicosin in association with administration of tilmicosin as prophylaxis for pneumonia . However , bacterial resistance to trimethoprim/sulfonamide and to oxytetracycline were commonly found in these postmortem isolates The objectives of this study were to determine ( i ) whether an association exists between individual pharmacokinetic parameters and treatment outcome when feeder cattle were diagnosed with bovine respiratory disease ( BRD ) and treated with gamithromycin ( Zactran ( ® ) ) at the label dose and ( ii ) whether there was a stronger association between treatment outcome and gamithromycin concentration in plasma or in the pulmonary epithelial lining fluid ( PELF ) effect compartment . The study design was a prospect i ve , blinded , r and omized clinical trial utilizing three groups of 60 ( 362 - 592 lb ) steers/bulls r and omly allocated within origin to sham injection or gamithromycin mass medication . Cattle were evaluated daily for signs of BRD by a veterinarian blinded to treatment . Animals meeting the BRD case definition were enrolled and allocated to a sample collection scheme consisting of sample s for bacterial isolation ( bronchoalveolar lavage fluid and nasopharyngeal swabs ) and gamithromycin concentration determination ( PELF and plasma ) . Gamithromycin susceptibility of M. haemolytica ( n = 287 ) and P. multocida ( n = 257 ) were determined using broth microdilution with frozen panels containing gamithromycin at concentrations from 0.03 to 16 μg/mL. A two-compartment plasma pharmacokinetic model with an additional compartment for gamithromycin in PELF was developed using rich data sets from published and unpublished studies . The sparse data from our study were then fit to this model using nonlinear mixed effects modeling to estimate individual parameter values . The result ing parameter estimates were used to simulate full time-concentration profiles for each animal in this study . These profiles were analyzed using noncompartmental methods so that PK/PD indices ( AUC24 /MIC , AUC∞ /MIC , CMAX /MIC ) could be calculated for plasma and PELF ( also T > MIC ) for each individual . The calculated PK/PD indices were indicative that for both M. haemolytica and P. multocida a higher drug exposure in terms of concentration , and duration of exposure relative to the MIC of the target pathogen , was favorable to a successful case outcome . A significant association was found between treatment success and PELF AUC0 - 24 /MIC for P. multocida . The calves in this study demonstrated an increased clearance and volume of distribution in plasma as compared to the healthy calves in two previously published reports . Ultimately , the findings from this study indicate that higher PK/PD indices were predictive of positive treatment outcomes Three studies were conducted to determine and confirm the effective dosage rate of ceftiofur crystalline-free acid sterile suspension ( CCFA-SS , 200 mg ceftiofur equivalents [CE]/ml ) , a long-acting ceftiofur formulation , for control and treatment of bovine respiratory disease ( BRD ) . In each study , CCFA-SS was administered once by subcutaneous ( SC ) injection in the middle third of the posterior aspect of the ear . Study 1 was conducted using an intratracheal challenge with Mannheimia ( formerly Pasteurella ) haemolytica and dosages ranging from 0 to 8.8 mg CE/kg to select a dosage for further field testing . In Study 2 , a single dose of CCFA-SS at 0.0 , 4.4 , or 6.6 mg CE/kg was administered when uniform clinical signs of BRD were present in feedlot cattle . Study 3 was conducted in several feedlots to evaluate the efficacy , practicality , and safety of CCFA-SS at 4.4 or 6.6 mg CE/kg compared with a placebo control or tilmicosin for preemptive control of BRD . In Study 1 , the effective dose was determined to be 5.35 mg CE/kg ; therefore , 4.4 and 6.6 mg CE/kg were selected as the dosages for further field testing . Administration of CCFA-SS at 4.4 or 6.6 mg CE/kg improved treatment success compared with negative controls ( P < or = .05 for both doses ) in Study 2 . In Study 3 , a single administration of 4.4 or 6.6 mg CE/kg was comparable to tilmicosin ( P < .001 ) and was significantly better than placebo ( P < .001 ) for the control of BRD . Using the ear as an administration site was acceptable under field conditions and was well tolerated by all animals . These studies demonstrated that a single administration of CCFA-SS by SC injection in the middle third of the posterior aspect of the ear at 4.4 or 6.6 mg CE/kg is effective , safe , and practical for preemptive control and treatment of the bacterial component of BRD in feedlot cattle . Administration in an inedible tissue results in a short withdrawal time and no injection-site trimming at slaughter Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Three studies conducted at feedlots in Colorado , Idaho , and Texas examined the comparative efficacy of tulathromycin injectable solution for the treatment of cattle at high risk of developing undifferentiated bovine respiratory disease ( BRD ) . Each study r and omly allocated 250 calves to receive tulathromycin at 2.5 mg/kg and 250 calves to receive either tilmicosin at 10 mg/kg ( Colorado site ) or florfenicol at 40 mg/kg ( Idaho and Texas sites ) on arrival at the feedlot . Calves were housed by treatment group in pens with 50 calves/pen . Beginning 3 days after antimicrobial treatment , cattle were observed for signs of BRD daily until harvest . In all three studies , the treatment success rates at 28 days after treatment and at harvest were significantly higher ( P < or = .013 ) for cattle treated with tulathromycin than for cattle treated with either tilmicosin or florfenicol . Fewer tulathromycin-treated cattle were removed from the group as " chronics " or " mortalities " at 28 days posttreatment ( P < or = .014 ) in all three studies . Tulathromycin demonstrated superior efficacy compared with tilmicosin and florfenicol when treating groups of high-risk cattle before the onset of signs of BRD OBJECTIVES To evaluate effects of tilmicosin when used in fever-based and metaphylactic treatment programs to attenuate acute undifferentiated bovine respiratory disease ( BRD ) in cattle that recently arrived at feedlots , and to evaluate the effects of tilmicosin for the treatment of BRD . DESIGN R and omized-block controlled study . ANIMALS 1,639 calves from livestock auctions . PROCEDURES Cattle were assigned to 3 groups . Cattle in the nonmedicated ( control ) group were not given antibiotics during processing . Cattle in the fever-based treatment group were given tilmicosin ( 10 mg/kg [ 4.5 mg/lb ] of body weight , s.c . ) during processing when their rectal temperature was > or = 40 C ( 104 F ) . All cattle in the metaphylactic treatment group were given tilmicosin ( 10 mg/kg , s.c . ) during processing . Calves with BRD were treated with tilmicosin ( 10 mg/kg , s.c . ) . RESULTS Morbidity rates in the metaphylactic ( 30.4 % ) and fever-based ( 44.7 % ) treatment groups were less than that for the nonmedicated group ( 54.8 % ) . Mortality rate for the metaphylactic group during the first 28 days ( 1.1 % ) and during the entire study ( 1.7 % ) was less than that for the nonmedicated group ( 3.3 and 4.6 % , respectively ) . Differences were not observed in therapeutic response rates among calves with BRD that were treated . CLINICAL IMPLICATION S Fever-based and metaphylactic treatment programs that used tilmicosin decreased the prevalence of BRD and improved growth of calves . Metaphylactic treatment decreased the number of fatalities caused by BRD in high-risk calves . Fever-based treatment was less effective than metaphylactic treatment for decreasing the prevalence of BRD in newly arrived cattle Feedlot calves ( n = 3784 ) were systematic ally r and omized and allocated in a 2 × 2 factorial study to receive metaphylactic oxytetracycline ( OTC ) on arrival or no antimicrobial , as well as florfenicol once subcutaneously or twice intramuscularly ( 48 h apart ) if diagnosed with bovine respiratory disease ( BRD ) . Calves of different treatment groups were comingled and followed from placement to re-implantation ( ~100 days ) . Animals receiving OTC had a reduced risk of BRD , an increased risk of arthritis , and no significant differences in average daily gain , BRD relapse , overall mortality , or BRD mortality . There were no significant differences between treatment protocol s. Deep nasal swabs ( n = 233 ) taken at arrival ( n = 122 ) , treatment ( n = 77 ) , and swabs from lungs and joints at postmortem ( n = 34 ) were cultured for Mycoplasma bovis from 61 animals ill or dying of chronic pneumonia and arthritis and from 61 healthy calves . There was significant variation in diversity among isolates ( n = 51 ) between study years and different cattle . Metaphylaxis or antimicrobial treatment did not affect the diversity of isolates . Except for tilmicosin , isolates were largely susceptible to tested antimicrobials R and omized controlled trials ( RCTs ) are the gold st and ard for evaluating efficacy of treatments under real world conditions and , as such , it is important that they are conducted with method ological rigour to prevent biased results . Many medical journals have adopted a st and ard checklist for reporting of RCTs , the CONSORT statement . The objective of this study was to evaluate clinical trials in livestock population s to assess method ological quality and completeness of reporting and to investigate the association between these criteria and treatment effects . A total of 100 clinical trials published between 2006 and 2008 in the English language were r and omly selected . For each trial , 2 review ers independently completed a checklist based on the CONSORT statement and a different 2 review ers completed a st and ard template describing the outcomes used and the statistical significance of all reported treatment effects . Disagreements among review ers were resolved by consensus . The results showed that there were substantive deficiencies in the reporting of many of trial features , both related to method ological quality and completeness of reporting . Details on key features such as r and omization , double blinding , and the number of subjects lost to follow-up were reported in only 67 , 4 , and 62 % of trials , respectively . Reporting of r and om allocation to treatment group was associated with a lower proportion of positive treatments effects within trials , as was reporting of inclusion /exclusion criteria for study subjects , details on the intervention , animal signalment , significance tests of baseline differences for at least one variable , and the methods used to measure all outcomes . The results suggest that there are deficiencies in the current reporting of important features of RCTs conducted in livestock species and that these deficiencies may be associated with biased treatment effects . The creation and adoption of Output:

The results suggest that macrolides are the most effective antibiotics for the reduction of BRD incidence . Injectable oxytetracycline effectively controlled BRD compared with no antibiotics ; however , it was less effective than macrolide treatment . Because oxytetracycline is already commonly used to prevent , control , and treat BRD in groups of feedlot cattle , the use of injectable oxytetracycline for BRD control might have advantages from an antibiotic stewardship perspective

MS2_1shot557

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: 11 mg natural progesterone ( P ) was administered to 20 healthy menopausal women by means of a nasal spray or intramuscular injection . Circulating P levels were calculated at various times after administration . The spray formulation yielded a CMax of 3.75 ng/ml at TMax = 60 min , the area under the curve (AUC)0 - 720 being 1,481.6 + /- 343 . Intramuscular administration yielded a mean CMax of 4.137 ng/ml at TMax = 240 min , the AUC0 - 720 being 2,491.2 + /- 540 . P absorption was faster through the nasal than through the intramuscular route , but intramuscular administration led to high serum levels for a much longer period Progesterone was administered to postmenopausal women in a form of vaginal suppositories containing 100 and 200 mg active substance in Butyrum cacao ( BC ) and Massa estarinum ( ME ) , a base with emulsifying properties . In the case of single doses , blood sample s were taken at 2 , 4 , 6 , 24 , 48 and 72 h. Another group of patients received vaginal suppositories ( 100 mg progesterone ) once a day for a 6 day period , with blood sample s taken 12 h after each administration . The plasma levels of progesterone were evaluated by radioimmunoassay . The time of maximum concentration ( tmax ) was 4 h in most cases , and 6 h in the others . The plasma levels were not dose-proportional . Peak plasma concentrations were in the range of 10 - 15 ng/ml with a mean of 10.5 ng/ml for the 100 mg and 12 ng/ml for the 200 mg doses . The ratio of the mean area under the curve ( AUC ) for 200 mg and the mean AUC for the 100 mg dose was found to be 1.37 . Replacing BC with ME result ed in the lowering of cmax and AUC , and an increase in tmax following a reducing in the rate and extent of adsorption . In the case of ME suppositories , the variability in AUC , cmax and tmax was greater compared to that observed with the BC suppositories . Elimination half-time was in the range of 9 - 10 h for BC and 14 h for ME suppositories . In vitro assessment of the release kinetics from a hydrophobic and an emulsion type base confirmed previous findings : the latter base assured better pharmaceutical availability . The repeated doses did not seem to produce an accumulation of progesterone in the plasma . On the contrary , a small decrease in plasma levels over time appeared during the 6 day period . Numerical analysis revealed an excellent goodness of fit for the in vivo experimental data via biexponential curves , i.e. a pseudomonocompartmental model Whilst only about a third of all cerebral palsy occurs in children who had been of low birthweight , recent increases in the survival of low and very low birthweight infants have coincided with significant increases in the numbers of cerebral palsy children amongst them . This paper analyses data from the Western Australian Cerebral Palsy Register and from the Maternal and Child Health Research Data Base for stillbirths , neonatal deaths and survivors to address the issues of increased survival , cerebral palsy and timing of brain damage . The analysis is inconclusive but suggestive that both antenatal and postnatal complications are important in the increases in cerebral palsy in low birthweight infants . The good news is that this means that a certain proportion of postnatally damaged low birthweight survivors could possibly be prevented by better neonatal care . The bad news is that the remaining proportion have probably received their damage well before delivery and the possibilities for prevention are still remote . Further studies of low birthweight infants with cerebral palsy are urgently required . They should include antenatal factors , investigating the various aetiological pathways to preterm birth , r and omised controlled trials of neonatal interventions and search ing for better neonatal predictors of brain damage OBJECTIVE This study was undertaken to determine whether progestational agents can prevent inflammation-induced preterm parturition and fetal demise . STUDY DESIGN The activation of contractile and inflammatory pathways in response to localized intrauterine inflammation was investigated by using quantitative polymerase chain reaction ( PCR ) . Serum progesterone ( P4 ) levels and alterations in progesterone receptor-B ( PR-B ) were determined with radioimmunoassay and quantitative PCR , respectively . With our in vivo model of intrauterine inflammation , animals were r and omly assigned to pretreatment with P4 or medroxyprogesterone acetate ( MPA ) before intrauterine lipopolysaccharide ( LPS ) . Animals were observed for preterm delivery . The number of live pups 48 hours after intrauterine LPS was recorded for each treatment group . The ability of MPA to alter signal transduction pathways leading to preterm parturition were investigated by quantitative PCR and histochemical studies . RESULTS Intrauterine inflammation is associated with decreased serum progesterone levels and decreased transcription of PR-B. Preterm delivery rates were 100 % for LPS alone , 63 % for LPS+P4 , and 0 % for LPS+MPA . No live pups remained at 48 hours in the LPS or LPS+P4 groups . Pretreatment with MPA significantly preserved fetal viability . MPA suppressed activation of contraction-associated genes and inflammatory mediators and prevented cervical ripening in response to intrauterine inflammation . CONCLUSION MPA , with its progestational and anti-inflammatory properties , prevented inflammation-induced preterm parturition and significantly preserved fetal viability A prior report suggested that active-duty pregnant women are at increased risk for low-birth weight infants and a higher perinatal mortality rate . The present double-blind investigation was design ed to prospect ively evaluate that risk and to test the efficacy of 17 alpha-hydroxyprogesterone caproate to prevent reported complications . Three groups of active-duty women were studied , beginning between 16 and 20 weeks ' gestation . They were similar for parity , previous abortion , race , cigarette smoking , and marital status . Of these , 80 were given 17 alpha-hydroxyprogesterone caproate , 88 received placebo , and 78 declined to participate in the protocol . There was no significant differences in the three groups when comparisons were made for low-birth weight infants and for perinatal mortality . However , when comparison was made to a military dependent population , they had a significantly worse outcome with regard to both perinatal mortality ( p = 0.001 ) and infants with a birth weight less than 2,500 gm ( p = 0.01 ) . We concluded that pregnant military personnel were at increased risk for adverse pregnancy outcome , but that this risk was not altered by therapy with 17 alpha-hydroxyprogesterone caproate OBJECTIVE The purpose of this study was to evaluate the effect of prophylactic vaginal progesterone in decreasing preterm birth rate in a high-risk population . STUDY DESIGN A r and omized , double-blind , placebo-controlled study included 142 high-risk singleton pregnancies . Progesterone ( 100 mg ) or placebo was administered daily by vaginal suppository and all patients underwent uterine contraction monitoring with an external tocodynamometer once a week for 60 minutes , between 24 and 34 weeks of gestation . Progesterone ( n = 72 ) and placebo ( n = 70 ) groups were compared for epidemiologic characteristics , uterine contraction frequency , and incidence of preterm birth . Data were compared by chi(2 ) analysis and Fisher exact test . RESULTS The preterm birth rate was 21.1 % ( 30/142 ) . Differences in uterine activity were found between the progesterone and placebo groups ( 23.6 % vs 54.3 % , respectively ; P < .05 ) and in preterm birth between progesterone and placebo ( 13.8 % vs 28.5 % , respectively ; P < .05 ) . More women were delivered before 34 weeks in the placebo group ( 18.5 % ) than in the progesterone group ( 2.7 % ) ( P < .05 ) . CONCLUSION Prophylactic vaginal progesterone reduced the frequency of uterine contractions and the rate of preterm delivery in women at high risk for prematurity BACKGROUND The aim was to study whether prolongation of luteal support during early pregnancy influences the delivery rate after IVF . METHODS Dual centre study including 303 women who achieved pregnancy after IVF or ICSI was used . All were treated with the long protocol using GnRH agonists and given luteal support with 200 mg vaginal progesterone three times daily during 14 days from the day of transfer until the day of a positive HCG test . The study group ( n = 150 ) withdrew vaginal progesterone from the day of positive HCG . The control group ( n = 153 ) continued administration of vaginal progesterone during the next 3 weeks of pregnancy . RESULTS The number of miscarriages prior to and after week 7 of gestation was seven ( 4.6 % ) and 15 ( 10.0 % ) in the study group and five ( 3.3 % ) and 13 ( 8.5 % ) in the control group respectively . The number of deliveries was 118 ( 78.7 % ) in the study group and 126 ( 82.4 % ) in the control group . The differences were not significant . CONCLUSIONS Prolongation of progesterone supplementation in early pregnancy has no influence on the miscarriage rate , and thus no effect on the delivery rate . Progesterone supplementation can safely be withdrawn at the time of a positive HCG test Eighty pregnant women at high risk of giving birth prematurely were divided r and omly into two groups . Treatment with either 17 alpha-hydroxyprogesterone caproate , 250 mg by intramuscular injection once a week , or a placebo was given in a double-blind fashion . Imminent premature labor occurred in 29.0 % of the treated group and in 59.4 % of the control group ( p less than 0.025 ) . The rate of premature deliveries was also significantly lower in the treated group ( 16.1 % ) than in the control group ( 37.82 % ) ( p less than 0.05 ) . There were no cases of perinatal death or fetal malformations in either group . The mean birth weight of all infants of the treated group was significantly higher than in those of the control group ( 3111.9 + /- 905 gm versus 2680 + /- 813.4 gm , p less than 0.05 ) . The results support treatment with progesterone caproate for the prevention of premature labor We conducted a double-blind study to determine the efficacy of 17alpha-hydroxyprogesterone caproate in preventing premature delivery in 43 high-risk patients . Premature delivery did not occur in 18 patients receiving the progestational agent , whereas 41 per cent of the 22 receiving the palcebo had premature delivery ( P less than 0.01 ) . The mean duration of pregnancy and the mean birth weight in the former group ( 38.6 weeks + /- 1.6 S.D. , and 2836 g + /- 412 S.D. ) were both significantly greater ( P less than 0.025 ) than that in the latter ( 35.2 weeks + /- 6.7 S.D. ; 2361 g + /- 1085 S.D. ) . The perinatal mortality rate in the group given the progestational agent ( O per cent ) was significantly less than that observed in the placebo group ( 27 per cent ) ( P less than 0.05 ) . Although there were no complications attributable to the progestational drug , the study population was too small for assessment of immediate or long term safety . However , the results indicate a possible obstetric use for this drug The use of luteal phase support has been demonstrated in patients undergoing an IVF/ET procedure . This study was design ed to compare the absorption and the efficacy of two different luteal supports : 17-alpha-hydroxyprogesterone caproate ( Lentogest , AMSA , Italy ) and natural Progesterone ( Prontogest , AMSA , Italy ) . A total of 80 patients received luteal supplementation with 50 mg of natural P/day intramuscularly , until beta-hCG evaluation . Then , in case of positive beta-hCG , patients were r and omly divided into two groups ( A and B ) in order to compare two different protocol s : Group A , 17-OHPc ( 341 mg once a week ) and Group B , natural P ( 50 mg/day ) both intramuscularly and extended for 10 - 12 weeks . Our study showed that the treatment with 17-OHPc results in a higher percentage of pregnancy rate compared to natural P , but the differences are not statistically significant . Thus , we emphasize that 17-OHPc preparation for better acceptance appears to be the most suitable and comfortable method for luteal phase support OBJECTIVE To analyse hospital readmissions to 1 year in infants < 33 weeks ' gestation . STUDY DESIGN Cohort of very preterm infants born in Western Australia . METHODS Parental social class , history of asthma , race , gestational age , birthweight , sex , severity of Output:

For progesterone supplementation to be advocated for women at the risk of preterm birth , the prolongation of gestation demonstrated in this meta- analysis must translate into improved infant outcomes , including a reduction in mortality . There is currently insufficient information to allow recommendations regarding the optimal dose , route , and timing of administration of progesterone supplementation

MS2_1shot558

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Economic information is necessary for rational decision-making in health care . Many European countries require financial impact statements prior to drug approval , and many health care organizations in the USA consider cost-effectiveness when making formulary decisions . We report the findings and discuss the policy implication s of an economic evaluation based on an international , r and omized controlled trial of salvage therapy for epithelial ovarian cancer , wherein topotecan and pegylated liposomal doxorubicin ( PLD ) were found to have similar efficacy but differing toxicities . PATIENTS AND METHODS Direct costs to the payer were estimated for 235 North American and 239 European trial participants who had relapsed or failed platinum-based therapy . Unit costs were obtained from national sources or previously reported economic analyses . Sensitivity analyses were also performed . RESULTS Total cost per person in the topotecan arm was 12,325 dollars ( 95 % CI 9445 dollars to 15,415 dollars ; P > 0.05 ) higher in the USA-based analysis and 2909 dollars ( 95 % CI 779 dollars to 3415 dollars ; P < 0.05 ) higher in the UK-based analysis than for PLD . Pegylated liposomal doxorubicin was cost saving over a wide range of assumptions . The main differences ( per person ) in toxicity management following PLD compared with topotecan in Europe were for blood transfusions ( 1190 dollars versus 181 dollars , respectively ) and hospitalizations ( 1197 dollars versus 280 dollars , respectively ) . In North America , differences were mainly for granulocyte colony stimulating factors ( 1936 dollars versus 419 dollars micro g , respectively ) , erythropoietin ( 3493 dollars versus 308 dollars , respectively ) and blood transfusions ( 1346 dollars versus 140 dollars , respectively ) . CONCLUSIONS Policy makers who evaluate pharmacoeconomic studies should consider international differences in health care delivery . Cost assessment s based on information obtained from one country may not be relevant for policy makers in a different country BACKGROUND In the CALYPSO trial , carboplatin-pegylated liposomal doxorubicin ( CD ) demonstrated superior therapeutic index versus carboplatin-paclitaxel ( CP ) in patients with recurrent ovarian cancer . This paper reports the health-related quality of life ( HRQoL ) findings . MATERIAL S AND METHODS HRQoL was measured with the EORTC QoL-QC30 question naire and OV28 ovarian cancer module . Mean change scores from baseline in HRQoL subscales ( five functional scales and global health status ) in each arm and the proportion of patients improved or worsened were calculated every 3 months until 12 months . RESULTS Compliance was 90 % at baseline and 76 % , 64 % , 57 % at 3 , 6 , and 9 months , respectively . Baseline HRQoL showed already impaired global scores ( mean 62/100 ) and considerable symptom burden ( 90 % of patients reporting nonzero scores ) . Global QoL and abdominal symptom scores improved over time in both arms ; at 6 months , 36 % of patients met criteria for improved symptoms . Treatment with CD result ed in less peripheral neuropathy ( 9.8 versus 24.2 ) , fewer other chemotherapy side-effects ( 9.5 versus 16.2 ) , and less impact on body image ( 3.8 versus 10.4 ) versus CP ( all P<0.02 ) at 6 months . CONCLUSIONS These patient-reported outcomes confirm the overall lower toxicity of CD versus CP . The improved disease-related outcomes achieved with CD were not at the expense of BACKGROUND Cost-effectiveness/cost-utility analyses are increasingly needed to inform decisions about care . Algorithms have been developed using the Functional Assessment of Cancer Therapy ( FACT ) quality of life instrument to estimate utility weights for cost analyses . This study was design ed to compare these algorithms in the setting of ovarian cancer . METHODS GOG-0152 was a 550-patient r and omized phase III trial of interval cytoreduction , and GOG-0172 was a 415-patient r and omized phase III trial comparing intravenous versus intraperitoneal therapy among women with advanced ovarian cancer . QOL data were collected via the FACT at four time points in each study . Two published mapping algorithms ( Cheung and Dobrez ) and a linear transformation method were applied to these data . The agreement between measures was assessed by the concordance correlation coefficient ( r(CCC ) ) , and paired t-tests were used to compare means . RESULTS While agreement between the estimation algorithms was good ( ranged from 0.72 to 0.81 ) , there were statistically significant ( p<0.001 ) and clinical ly meaningful differences between the scores : mean scores were higher with Dobrez than with Cheung or the linear transformation method . Scores were also statistically significantly different ( p<0.001 ) between studies . CONCLUSIONS In the absence of prospect ively collected utility data , the use of mapping algorithms is feasible , however , the optimal algorithm is not clear . There were significant differences between studies , which highlight the need for validation of these algorithms in specific setting s. If cost analyses incorporate mapping algorithms to obtain utility estimates , investigators should take the variability into account BACKGROUND We have continued to monitor the survival of patients r and omised in a previously reported multicentre phase III study of topotecan versus paclitaxel in patients with advanced epithelial ovarian cancer who had failed one prior platinum-based regimen . PATIENTS AND METHODS Patients with bidimensionally measurable disease were r and omised to topotecan ( 1.5 mg/m(2)/day for 5 days ) or paclitaxel ( 175 mg/m(2)/day as a 3-h infusion ) every 21 days . Patients were eligible for treatment with the alternate therapy at third line . The European Organisation for Research and Treatment of Cancer Quality of Life ( EORTC QOL)-C30 question naire was also used to measure eight symptoms at baseline and during each course ( pain , anorexia , diarrhoea , fatigue , nausea and vomiting , dyspnea , constipation and insomnia ) . RESULTS A total of 226 patients were evaluable for response . Demographic characteristics were similar in both treatment groups , as were results of the EORTC QOL-30 question naire . For the topotecan group , median time to progression was 18.9 weeks ( range < 1 to 92.6 + weeks ; 25 % censored ) , and , for paclitaxel , 14.7 weeks ( range < 1 to 137.3 + weeks ; 12.3 % censored ) ; P = 0.076 . At 4 years post-r and omisation , median survival in the topotecan group was 63.0 weeks ( range < 1 to 238.4 + weeks ; 20.5 % censored ) and , for paclitaxel , 53.0 weeks ( range < 1 to 226.3 + weeks ; 12.3 % censored ) ; P = 0.44 . CONCLUSION Topotecan continues to demonstrate comparable efficacy and survival to paclitaxel with manageable and non-cumulative haematological toxicity . Non-haematological toxicity was generally mild for both groups . The long-term survival rate indicates substantial therapeutic benefit for this group of patients receiving topotecan at relapse of ovarian cancer BACKGROUND CALYPSO ( CAeLYx in Platinum Sensitive Ovarian ) patients compared carboplatin-pegylated liposomal doxorubicin ( C-PLD ) with carboplatin-paclitaxel ( C-P ) in patients with late-relapsing recurrent ovarian cancer ( ROC ) . We analyzed outcomes in patients ≥70 years . PATIENTS AND METHODS Nine hundred and seventy-six patients with taxane-pretreated ROC relapsing > 6 months after first- or second-line platinum-based therapy were r and omly assigned to 4-weekly C area under the curve ( AUC ) 5 plus PLD 30 mg/m(2 ) or 3-weekly C AUC 5 plus P 175 mg/m(2 ) for six or more cycles . RESULTS One hundred and fifty-seven ( 16 % ) patients ≥70 years ( median : 74 years , C-PLD ; 73 years , C-P ; range 70 - 82 years ) were included ( n = 71 , C-PLD ; n = 86 , C-P ) . In comparing elderly and younger , elderly patients experienced fewer grade ≥2 allergic reactions ( P = 0.005 ) but more grade ≥2 sensory neuropathy ( P = 0.007 ) . Myelosuppression did not differ with age . Elderly patients completed planned treatment as frequently as younger ( 79 % , C-PLD ; 82 % , C-P ) . In comparing arms within elderly patients , C-P was associated with more grade ≥2 alopecia , sensory neuropathy , arthralgia/myalgia ( P < 0.001 for all ) , severe leukopenia plus febrile neutropenia ; C-PLD was associated with more grade ≥2 h and -foot syndrome ( P = 0.005 ) . Median progression-free survival was 11.6 months ( C-PLD ) and 10.3 months ( C-P ; P = 0.44 ) . CONCLUSIONS Patients ≥70 years experienced more neuropathy , with a higher incidence in the C-P arm . Similar to all study patients , C-PLD provided a better therapeutic index with less toxicity than C-P in elderly women with platinum-sensitive ROC PURPOSE This r and omized , multicenter , phase III noninferiority trial was design ed to test the efficacy and safety of the combination of pegylated liposomal doxorubicin ( PLD ) with carboplatin ( CD ) compared with st and ard carboplatin and paclitaxel ( CP ) in patients with platinum-sensitive relapsed/recurrent ovarian cancer ( ROC ) . PATIENTS AND METHODS Patients with histologically proven ovarian cancer with recurrence more than 6 months after first- or second-line platinum and taxane-based therapies were r and omly assigned by stratified blocks to CD ( carboplatin area under the curve [ AUC ] 5 plus PLD 30 mg/m(2 ) ) every 4 weeks or CP ( carboplatin AUC 5 plus paclitaxel 175 mg/m(2 ) ) every 3 weeks for at least 6 cycles . Primary end point was progression-free survival ( PFS ) ; secondary end points were toxicity , quality of life , and overall survival . RESULTS Overall 976 patients were recruited . With median follow-up of 22 months , PFS for the CD arm was statistically superior to the CP arm ( hazard ratio , 0.821 ; 95 % CI , 0.72 to 0.94 ; P = .005 ) ; median PFS was 11.3 versus 9.4 months , respectively . Although overall survival data are immature for final analysis , we report here a total of 334 deaths . Overall severe nonhematologic toxicity ( 36.8 % v 28.4 % ; P < .01 ) leading to early discontinuation ( 15 % v 6 % ; P < .001 ) occurred more frequently in the CP arm . More frequent grade 2 or greater alopecia ( 83.6 % v 7 % ) , hypersensitivity reactions ( 18.8 % v 5.6 % ) , and sensory neuropathy ( 26.9 % v 4.9 % ) were observed in the CP arm ; more h and -foot syndrome ( grade 2 to 3 , 12.0 % v 2.2 % ) , nausea ( 35.2 % v 24.2 % ) , and mucositis ( grade 2 - 3 , 13.9 % v 7 % ) in the CD arm . CONCLUSION To our knowledge , this trial is the largest in recurrent ovarian cancer and has demonstrated superiority in PFS and better therapeutic index of CD over st and ard CP BACKGROUND To perform a subset analysis of patients with partially platinum-sensitive recurrent ovarian cancer ( ROC ) who received either CD [ carboplatin-pegylated liposomal doxorubicin ( PLD ) ] or CP ( carboplatin-paclitaxel ) in the CALYPSO trial . PATIENTS AND METHODS CALYPSO , an international phase III , non-inferiority trial , enrolled women with ROC that relapsed > 6 months following first- or second-line therapy . Patients were r and omized to CD or CP . Patients with a treatment-free interval of > 6 and ≤ 12 months were evaluated for progression-free survival ( PFS ) , the primary end point of CALYPSO trial , and safety . RESULTS A total of 344 partially platinum-sensitive patients were included ( N = 161 , CD and N = 183 , CP ) . The hazard ratio for PFS was 0.73 ( 95 % confidence interval : 0.58 - 0.90 ; P = 0.004 for superiority ) in favor of CD . Median PFS times were 9.4 months ( CD ) and 8.8 months ( CP ) Output:

In people with platinum-sensitive disease , NMA found statistically significant benefits for PLDH plus platinum , and paclitaxel plus platinum for overall survival ( OS ) compared with platinum monotherapy . PLDH plus platinum significantly prolonged progression-free survival ( PFS ) compared with paclitaxel plus platinum . Of the non-platinum-based treatments , PLDH monotherapy and trabectedin plus PLDH were found to significantly increase OS , but not PFS , compared with topotecan monotherapy . In people with platinum-resistant/-refractory ( PRR ) disease , NMA found no statistically significant differences for any treatment compared with alternative regimens in OS and PFS . LIMITATIONS As platinum- and non-platinum-based treatments were evaluated separately , the comparative clinical effectiveness and cost-effectiveness of these regimens is uncertain in patients with platinum-sensitive disease . CONCLUSIONS For platinum-sensitive disease , it was not possible to compare the clinical effectiveness and cost-effectiveness of platinum-based therapies with non-platinum-based therapies . For people with platinum-sensitive disease and treated with non-platinum-based therapies , it is unclear whether PLDH would be considered cost-effective compared with paclitaxel at a threshold of £ 30,000 per additional QALY ; trabectedin plus PLDH is unlikely to be considered cost-effective compared with PLDH . For patients with PRR disease , it is unlikely that topotecan would be considered cost-effective compared with PLDH .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Introduction The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado . Previous reports evaluated the project among Medicare and Medicaid enrollees in the state . In this report , we evaluate the program among enrollees in the state 's five major insurance plans . Methods We compared the Tepeyac Project 's two interventions : the Printed Intervention and the Promotora Intervention . In the first , we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use . In the second , promotoras ( peer counselors ) in four Catholic churches delivered breast-health education messages personally . We compared biennial mammogram cl aims from the five insurance plans in the analysis at baseline ( 1998–1999 ) and during follow-up ( 2000–2001 ) for Latinas who had received the interventions . We used generalized estimating equations ( GEE ) analysis to adjust rates for confounders . Results The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up ( 58 % [ 2979/5130 ] vs 58 % [ 3338/5708 ] ) . In the Promotora Intervention , the rate was 59 % ( 316/536 ) at baseline and 61 % ( 359/590 ) at follow-up . Rates increased modestly over time and varied widely by insurance type . After adjusting for age , income , urban versus rural location , disability , and insurance type , we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention ( GEE parameter estimate = .24 [ ±.11 ] , P = .03 ) . Conclusion For insured Latinas , personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational material s to churches Background Cancer is the leading cause of death among Asian Americans . While Asian Americans are the fastest growing minority population in the United States , they are underrepresented in cancer research and report poor adherence to cancer screening guidelines . Purpose This study utilized data from two large r and omized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community setting s and Chinese American physician practice s. Findings will inform effective strategies for promoting Asian American participation in cancer control research . Methods Chinese Americans who were non-adherent to annual mammography screening guidelines ( Study 1 with 664 immigrant women > 40 years of age ) and to colorectal cancer screening guidelines ( Study 2 with 455 immigrants > 50 years of age ) were enrolled from the greater Washington DC , New York City ( NYC ) , and Philadelphia ( PA ) areas . Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent . Study 1 adopted community approaches and worked with community organizations to enroll participants . Study 2 r and omly selected potential participants through 24 Chinese American primary -care physician offices , and mailed letters from physicians to enroll patients , followed by telephone calls from research staff . The success of recruitment approaches was assessed by yield rates based on number of participants approached , ineligible , and consented . Results Most participants ( 70 % ) of Study 1 were enrolled through in-person community approaches ( e.g. , Chinese schools , stores , health fairs , and personal networks ) . The final yield of specific venues differed widely ( 6 % to 100 % ) due to various proportions of ineligible subjects ( 2%–64 % ) and refusals ( 0%–92 % ) . The Study 2 recruitment approach ( physician letter followed by telephone calls ) had different outcomes in two geographic areas , partially due to differences in demographic characteristics in the DC and NYC/PA areas . The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach ( p < .001 ) . Enrollment cost is provided to inform future research studies . Limitations Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American population s because they may vary by study protocol s ( e.g. , length of trials ) , target population s ( i.e. , eligibility criteria ) , and available re sources . Conclusions Use of multiple culturally relevant strategies ( e.g. , building trusting relationships through face-to-face enrollment , use of bilingual and bicultural staff , use of a physician letter , and employing linguistically appropriate material s ) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical setting s. Our data demonstrate that substantial effort is required for recruitment ; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research OBJECTIVES To describe both conditions of a two-group r and omized trial , one that promotes physical activity and one that promotes cancer screening , among churchgoing Latinas . The trial involves promotoras ( community health workers ) targeting multiple levels of the Ecological Model . This trial builds on formative and pilot research findings . DESIGN Sixteen churches were r and omly assigned to either the physical activity intervention or cancer screening comparison condition ( approximately 27 women per church ) . In both conditions , promotoras from each church intervened at the individual- ( e.g. , beliefs ) , interpersonal- ( e.g. , social support ) , and environmental- ( e.g. , park features and access to health care ) levels to affect change on target behaviors . MEASUREMENTS The study 's primary outcome is min/wk of moderate-to-vigorous physical activity ( MVPA ) at baseline and 12 and 24 months following implementation of intervention activities . We enrolled 436 Latinas ( aged 18 - 65 years ) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer , attended church at least four times per month , lived near their church , and did not have a health condition that could prevent them from participating in physical activity . Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months . SUMMARY Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities BACKGROUND Despite evidence of a decline in both incidence and prevalence of colorectal cancer nationwide , it remains the second most commonly diagnosed cancer and the third highest cause of mortality among Asian Americans , including Korean Americans . This community-based and theoretically guided study evaluated a culturally appropriate intervention program that included a bilingual cancer educational program among Korean Americans including information on CRC risks , counseling to address psychosocial and access barriers , and patient navigation assistance . METHODS A two-group quasi-experimental design with baseline and post-intervention assessment and a 12-month follow-up on screening was used in the study . Korean Americans ( N=167 ) were enrolled from six Korean churches . The intervention group received culturally appropriate intervention program addressing accessibility and psychosocial barriers , and navigation assistance for screening . The control group received general health education that included cancer-related health issues and screening . RESULTS There was a significant difference ( p<0.05 ) between the post-intervention and control groups in awareness of CRC risk factors . There was also a significant improvement in the pre-post across HBM measures in the intervention group for perceived susceptibility ( p<0.05 ) and benefits and barriers to screening ( p<0.001 ) . At baseline , 13 % of participants in the intervention group and 10 % in control group reported having had a CRC cancer screening test in the previous year . At the 12-month post-intervention follow-up , 77.4 % of participants in the intervention group had obtained screening compared to 10.8 % in the control group . CONCLUSION While health disparities result from numerous factors , a culturally appropriate and church-based intervention can be highly effective in increasing knowledge of and access to , and in reducing barriers to CRC screening among underserved Koreans INTRODUCTION Health communication interventions have been modestly effective for increasing informed decision making for prostate cancer screening among African-American men ; however , knowledge and informed decision making is still question able even with screening . Church-based programs may be more effective if they are spiritually based in nature . OBJECTIVE The aims of the present study were to implement and provide an initial evaluation of a spiritually based prostate cancer screening informed decision making intervention for African-American men who attend church , and determine its efficacy for increasing informed decision making . DESIGN AND METHOD Churches were r and omized to receive either the spiritually based or the non-spiritual intervention . Trained community health advisors , who were African-American male church members , led an educational session and distributed educational print material s. Participants completed baseline and immediate follow-up surveys to assess the intervention impact on study outcomes . RESULTS The spiritually based intervention appeared to be more effective in areas such as knowledge , and men read more of their material s in the spiritually based group than in the non-spiritual group . CONCLUSIONS Further examination of the efficacy of the spiritually based approach to health communication is warranted Background . African American ( AA ) men continue to have a greater than twofold risk of dying from prostate cancer compared to Whites . Methods . This community-based intervention study employed a quasi-experimental , delayed-control ( cross-over ) design with r and omization at the church-level ( N=345 AA men ) . Results . Logistic regression analyses revealed that the level of knowledge ( b=.61 , P<.05 , Exp (B)=1.84 ) , the perception of risk ( b=2.99 , P<.01 , Exp (B)=19.95 ) , and having insurance ( b=3.20 , P<.01 , Exp (B)=24.65 ) significantly increased the odds of participants who needed screening getting screened during study . Discussion . This study demonstrated the need for education , community involvement , and increased access to encourage minority men to obtain needed health screenings Output:

The majority of these studies review ed used pre-post , posttest only with control group , or quasi-experience design s. The Health Belief Model was the most commonly used theory in both groups . Community-based participatory research and empowerment/ecological frameworks were also used frequently in the Latino/Hispanic studies . Small media and group education were the top two most popular intervention strategies in both groups . Although one-on-one strategy was used in some Latino studies , neither group used reducing client out-of-pocket costs strategy . Client reminders could also be used more in both groups as well . Current review showed church-based cancer education programs were effective in changing knowledge , but not always screening utilization . Results show faith-based cancer educational interventions are promising .

MS2_1shot560

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Shigellosis is still an important health problem in developing and underdeveloped countries as it is resistance to commonly used antibiotics including ampicillin , trimethoprim-sulfamethoxazole , chloramphenicol and tetracycline . Between May 1996 and October 1996 , in a prospect i ve r and omized double-blind trial , cefixime was compared with ampicillin-sulbactam , both given orally for a period of 5 days , for the treatment of 80 children with acute bloody diarrhea . Forty patients were treated with a single-dose ( 8 mg/kg per day ) of cefixime and the other 40 patients were given three doses of 100 mg/kg per day of ampicillin-sulbactam . After identification of Shigella organisms in stool specimens , nine patients in the cefixime receiving group and six patients in the ampicillin-sulbactam receiving group were excluded from the study . Differences in average age , sex and weight between the cefixime and ampicillin-sulbactam group were statistically meaningless ( P > 0.05 ) . Fever and bloody diarrhea were universal features . The efficacy of cefixime was found to be better than ampicillin-sulbactam . Patients given cefixime had a shorter duration of fever ( P < 0.01 ) , shorter duration to disappearance of blood in the stool ( P < 0.01 ) , reduced time with diarrhea ( P < 0.01 ) and reduced hospitalization time during the 5 study days ( P < 0.01 ) than patients given ampicillin-sulbactam . No adverse effects were observed in the two study groups . This controlled trial showed good efficacy with cefixime compared to ampicillin-sulbactam in the treatment of shigellosis . Single-dose daily oral therapy with cefixime also showed good tolerability . Cefixime should be considered as an alternative drug of choice for shigellosis in children A single-blind , parallel , r and omized study comparing the efficacy of furazolidone and ampicillin in the treatment of children with acute invasive diarrhea was conducted among out patients at the Hospital General de Ciudad Nezahualcoyotl in Mexico between August 1986 and October 1987 . Seventy-eight patients were admitted to the study ; 39 were r and omized to receive furazolidone ( 5 mg/kg/day for 5 days ) , and 39 were r and omized to receive ampicillin ( 100 mg/kg/day for 5 days ) . The enteropathogens Shigella sp , Salmonella sp , and Escherichia coli were isolated in 87.2 % of the initial stool cultures . A preliminary assessment of the patients ' clinical status was made on day 3 . At that time 97.4 % of furazolidone patients had improved , compared with 65.7 % of patients in the ampicillin group ( p = 0.002 ) . At the end of the treatment period ( day 6 ) , 100 % of evaluable patients treated with furazolidone had a negative stool culture , compared with 71 % of evaluable patients treated with ampicillin ( p = 0.002 ) . Both absence of watery stools by day 5 and a negative day 6 stool culture determined treatment success . Overall , there was a greater percentage of treatment successes in the furazolidone group than in the ampicillin group ( 92.3 % versus 51.3 % , p = 0.001 ) . Tolerance to both drugs was very good . One patient treated with ampicillin developed urticaria , which required discontinuation of treatment ; the reaction resolved spontaneously after treatment discontinuation . No adverse reactions were reported in the furazolidone group . The results of this study showed that furazolidone was more effective than ampicillin in the treatment of acute invasive diarrhea . It is suggested that furazolidone should be the treatment of choice for this disease Background The burden of shigellosis is greatest in re source -poor countries . Although this diarrheal disease has been thought to cause considerable morbidity and mortality in excess of 1,000,000 deaths globally per year , little recent data are available to guide intervention strategies in Asia . We conducted a prospect i ve , population -based study in six Asian countries to gain a better underst and ing of the current disease burden , clinical manifestations , and microbiology of shigellosis in Asia . Methods and Findings Over 600,000 persons of all ages residing in Bangladesh , China , Pakistan , Indonesia , Vietnam , and Thail and were included in the surveillance . Shigella was isolated from 2,927 ( 5 % ) of 56,958 diarrhoea episodes detected between 2000 and 2004 . The overall incidence of treated shigellosis was 2.1 episodes per 1,000 residents per year in all ages and 13.2/1,000/y in children under 60 months old . Shigellosis incidence increased after age 40 years . S. flexneri was the most frequently isolated Shigella species ( 1,976/2,927 [ 68 % ] ) in all sites except in Thail and , where S. sonnei was most frequently detected ( 124/146 [ 85 % ] ) . S. flexneri serotypes were highly heterogeneous in their distribution from site to site , and even from year to year . PCR detected ipaH , the gene encoding invasion plasmid antigen H in 33 % of a sample of culture-negative stool specimens . The majority of S. flexneri isolates in each site were resistant to amoxicillin and cotrimoxazole . Ciprofloxacin-resistant S. flexneri isolates were identified in China ( 18/305 [ 6 % ] ) , Pakistan ( 8/242 [ 3 % ] ) , and Vietnam ( 5/282 [ 2 % ] ) . Conclusions Shigella appears to be more ubiquitous in Asian impoverished population s than previously thought , and antibiotic-resistant strains of different species and serotypes have emerged . Focusing on prevention of shigellosis could exert an immediate benefit first by substantially reducing the overall diarrhoea burden in the region and second by preventing the spread of panresistant Shigella strains . The heterogeneous distribution of Shigella species and serotypes suggest that multivalent or cross-protective Shigella vaccines will be needed to prevent shigellosis in Asia Following a nationwide outbreak of Shigella dysentery type 1 and the recognition of Shigella isolates resistant to ampicillin , the drug of choice , we conducted a clinical trial to compare the efficacy of ampicillin v. trimethoprim-sulphamethoxazole for the treatment of Shigella dysentery . Patients with symptoms of dysentery and no other complicating illness were r and omized into one of two treatment groups . Patients in the two groups were comparable at the time of hospital admission with regard to age , sex , presenting complaints and Shigella strains . They responded well with both regimens and there was no significant difference in the mean time until stool became culture negative ( 1.4 days ) , temperatures returned to normal ( 2.7 days ) and faecal leucocytes disappeared ( 3.0 days ) ; abdominal pain , tenesmus and stool blood and mucus improved significantly more rapidly with trimethoprim-sulphamethoxazole than with ampicillin . There was no evidence of toxicity with either drug . While both drugs are effective for the treatment of Shigella dysentery , trimethoprim-sulphamethoxazole was considered to be superior BACKGROUND Shigella species infections coupled with increased levels of antimicrobial resistances are major public health problems in developing countries particularly in children . OBJECTIVES The present study was conducted to determine the prevalence and antimicrobial resistance pattern of Shigella species among patients with diarrhea at Felege Hiwot Referral Hospital . METHODS A cross-sectional prospect i ve study was undertaken among patients with diarrhea ( n=215 ) from August to November 2009 . A4 pre-tested structured question naire was used for collecting data . Stool sample s were investigated for identification of Shigella species following st and ard procedures and antimicrobial susceptibility tests were performed using disc diffusion technique . RESULTS The isolation rate of Shigella species was 32/215 [ 14.9 % ( 95 % CI . : 10.5 - 20.5 ) ] , with high prevalence in patents under five years of age . Educational level , latrine usage , source of drinking water , and h and washing habits showed a statistically significant association with the prevalence of Shigella species ( p = 0.004 ) . All isolates of Shigella species were susceptible to ciprofloxacin and high level of sensitivity was observed for norfloxacin ( 90.6 % ) and gentamicin ( 75 % ) . Multiple drug resistance to as many as nine antibiotics was also detected CONCLUSION High prevalence of Shigella with multiple antibiotic resistance isolates was observed in this study . Public health workers should emphasize , on primary preventive measures and periodic surveillance for antibiotic susceptibility pattern of Shigella isolates . When culturing and antibiotic susceptibility testing facilities are not available , prescription of ciprofloxacin as a choice of treatment is recommended A prospect i ve r and omized study was conducted at an infectious disease hospital in Thail and . Ceftibuten was compared with norfloxacin , both given orally for five days for treatment of acute gastroenteritis in children . One hundred and seventy cases were included in the study . Eighty-eight cases were treated with ceftibuten and eighty-two cases with norfloxacin . The baseline characteristics of the patients in both treatment groups were similar . The results showed that mean duration s of diarrhea in the ceftibuten and norfloxacin groups were 2.48 days and 2.29 days , respectively , but there was no statistically significant difference between the two groups ( p > 0.05 ) . There were Salmonella spp and Shigella spp isolated in both treatment groups and all were susceptible to both antibiotics . The mean duration s of Salmonella diarrhea in the ceftibuten and norfloxacin groups were 2.7 and 2.2 days , respectively , while those of Shigella diarrhea were 2.3 days and 2.0 days , respectively . There were no statistically significant differences in either comparison ( p > 0.05 ) . Neither complications nor clinical relapses were observed after both antibiotics ' treatment Background The bacterial genus Shigella is the leading cause of dysentery . There have been significant increases in the proportion of Shigella isolated that demonstrate resistance to nalidixic acid . While nalidixic acid is no longer considered as a therapeutic agent for shigellosis , the fluoroquinolone ciprofloxacin is the current recommendation of the World Health Organization . Resistance to nalidixic acid is a marker of reduced susceptibility to older generation fluoroquinolones , such as ciprofloxacin . We aim ed to assess the efficacy of gatifloxacin versus ciprofloxacin in the treatment of uncomplicated shigellosis in children . Methodology /Principal Findings We conducted a r and omized , open-label , controlled trial with two parallel arms at two hospitals in southern Vietnam . The study was design ed as a superiority trial and children with dysentery meeting the inclusion criteria were invited to participate . Participants received either gatifloxacin ( 10 mg/kg/day ) in a single daily dose for 3 days or ciprofloxacin ( 30 mg/kg/day ) in two divided doses for 3 days . The primary outcome measure was treatment failure ; secondary outcome measures were time to the cessation of individual symptoms . Four hundred and ninety four patients were r and omized to receive either gatifloxacin ( n = 249 ) or ciprofloxacin ( n = 245 ) , of which 107 had a positive Shigella stool culture . We could not demonstrate superiority of gatifloxacin and observed similar clinical failure rate in both groups ( gatifloxacin ; 12.0 % and ciprofloxacin ; 11.0 % , p = 0.72 ) . The median ( inter-quartile range ) time from illness onset to cessation of all symptoms was 95 ( 66–126 ) hours for gatifloxacin recipients and 93 ( 68–120 ) hours for the ciprofloxacin recipients ( Hazard Ratio [ 95%CI ] = 0.98 [ 0.82–1.17 ] , p = 0.83 ) . Conclusions We conclude that in Vietnam , where nalidixic acid resistant Shigellae are highly prevalent , ciprofloxacin and gatifloxacin are similarly effective for the treatment of acute shigellosis . Trial Registration Controlled trials number IS RCT The efficacy of oral pivmecillinam was compared with nalidixic acid in the treatment of acute shigellosis in children 1 - 8 years of age . In a double-blind trial we studied 80 comparable children with bloody diarrhoea of less than 3 days ' duration . Shigella spp . was isolated in 71 children . Patients were r and omly assigned to receive either pivmecillinam , 50 mg/kg.day , or nalidixic acid , 60 mg/kg.day , both given orally for 5 days . The stool frequency decreased progressively in Output:

No evidence of publication bias was found in this analysis of studies of diagnostic value . INTERPRETATION Current WHO guidelines appear to manage dysentery effectively , but might miss opportunities to reduce mortality among children infected with Shigella who present without bloody stool .

MS2_1shot561

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Clinical and experimental studies have suggested that unfractionated heparin ( UFH ) effects malignancy progression . We review ed all published clinical reports concerning the effects of UFH , as compared to no treatment on survival of cancer patients . Studies were classified on method ological strength and subdivided as to whether therapeutic or prophylactic dosages of UFH were used . Mortality rates after 3 years were extracted or calculated . One r and omized study that evaluated the use of UFH in therapeutic dosages in patients with small cell lung carcinoma reported on an improved survival ( odds ratio ( OR ) 0.64 ; 95 % confidence interval ( CI ) : 0.25 to 1.62 ) . A detrimental effect was observed in 2 r and omized studies which investigated the effects of intraportal UFH treatment in a prophylactic dose after surgery for gastrointestinal cancer ( OR 1.66 ; 95 % CI : 1.02 to 2.71 ) . In contrast , level 2 studies in which either therapeutic or prophylactic dosages of UFH on mortality of patients with gastrointestinal cancer were evaluated , showed OR of 0.58 ( 95 % CI ; 0.11 - 3.13 ) and 0.65 ( 95 % CI 0.51 to 0.84 ) , respectively . We conclude that there is no convincing evidence of either positively or negatively effects of UFH on survival of patients with malignancy A small proportion of patients with deep vein thrombosis develop recurrent venous thromboembolic complications or bleeding during anticoagulant treatment . These complications may occur more frequently if these patients have concomitant cancer . This prospect i ve follow-up study sought to determine whether in thrombosis patients those with cancer have a higher risk for recurrent venous thromboembolism or bleeding during anticoagulant treatment than those without cancer . Of the 842 included patients , 181 had known cancer at entry . The 12-month cumulative incidence of recurrent thromboembolism in cancer patients was 20.7 % ( 95 % CI , 15.6%-25.8 % ) versus 6.8 % ( 95 % CI , 3.9%- 9.7 % ) in patients without cancer , for a hazard ratio of 3.2 ( 95 % CI , 1.9 - 5.4 ) The 12-month cumulative incidence of major bleeding was 12.4 % ( 95 % CI , 6.5%-18.2 % ) in patients with cancer and 4.9 % ( 95 % CI , 2.5%-7.4 % ) in patients without cancer , for a hazard ratio of 2.2 ( 95 % CI , 1.2 - 4.1 ) . Recurrence and bleeding were both related to cancer severity and occurred predominantly during the first month of anticoagulant therapy but could not be explained by sub- or overanticoagulation . Cancer patients with venous thrombosis are more likely to develop recurrent thromboembolic complications and major bleeding during anticoagulant treatment than those without malignancy . These risks correlate with the extent of cancer . Possibilities for improvement using the current paradigms of anticoagulation seem limited and new treatment strategies should be developed OBJECTIVE To prospect ively assess whether low-molecular-weight heparin ( LMWH ) provides a survival benefit in patients with advanced cancer . PATIENTS AND METHODS Between December 1998 and June 2001 , we performed a r and omized controlled study of patients with advanced cancer . Initially , the study was double blinded and placebo controlled , with the patients receiving daily injections of 5000 U of LMWH or saline . However , because of low accrual midway through the study , the placebo injection arm was eliminated , and the study became open labeled , with patients receiving either LMWH injections plus st and ard clinical care or st and ard clinical care alone . The primary study end point was overall survival . RESULTS Of 141 patients r and omized to this clinical trial , 3 dropped out , leaving 138 patients . The median survival time was 10.5 months ( 95 % confidence interval , 7.6 - 12.2 months ) for the combined st and ard care and placebo groups . The median survival time for the combined LMWH arms was 7.3 months ( 95 % confidence interval , 4.8 - 12.2 months ) . These median survival times were not significantly different ( log-rank P = .46 ) . The median survival times for the blinded and unblinded LMWH groups were 6.2 months and 9.0 months , respectively . The median survival times were 10.3 months for the blinded placebo arm and 10.5 months for the st and ard care arm . The rate of severe or life-threatening venous thromboembolism was 6 % in the LMWH arms and 7 % in the control arms . The rate of severe or life-threatening bleeding was 3 % in the LMWH arms and 7 % in the control arms Background . A positive influence of anticoagulant treatment in small cell lung cancer ( SCLC ) has been sug gested by experimental and clinical data BACKGROUND Small cell lung cancer ( SCLC ) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression . SCLC is associated with alterations in the coagulation system . The present r and omized clinical trial ( RCT ) was design ed to determine whether addition of low-molecular-weight heparin ( LMWH ) to combination chemotherapy ( CT ) would improve SCLC outcome compared with CT alone . METHODS Combination CT consisted of cyclophosphamide , epirubicine and vincristine ( CEV ) given at 3-weekly intervals for six cycles . Eighty-four patients were r and omized to receive either CT alone ( n = 42 ) or CT plus LMWH ( n = 42 ) . LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT . Results Overall tumor response rates were 42.5 % with CT alone and 69.2 % with CT plus LMWH ( P = 0.07 ) . Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH ( P = 0.01 ) . Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH ( P = 0.01 ) . Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages . The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 ( 95 % confidence interval 0.30 , 0.86 ) ( P = 0.012 by log rank test ) . Toxicity from the experimental treatment was minimal and there were no treatment-related deaths . CONCLUSIONS These results support the concept that anticoagulants , and particularly LMWH , may improve clinical outcomes in SCLC . Further clinical trials of this relatively non-toxic treatment approach are indicated PURPOSE Studies in cancer patients with venous thromboembolism suggested that low molecular weight heparin may prolong survival . In a double-blind study , we evaluated the effect of low molecular weight heparin on survival in patients with advanced malignancy without venous thromboembolism . METHODS Patients with metastasized or locally advanced solid tumors were r and omly assigned to receive a 6-week course of subcutaneous nadroparin or placebo . The primary efficacy analysis was based on time from r and om assignment to death . The primary safety outcome was major bleeding . RESULTS In total , 148 patients were allocated to nadroparin and 154 patients were allocated to placebo . Mean follow-up was 1 year . In the intention-to-treat analysis the overall hazard ratio of mortality was 0.75 ( 95 % CI , 0.59 to 0.96 ) with a median survival of 8.0 months in the nadroparin recipients versus 6.6 months in the placebo group . After adjustment for potential confounders , the treatment effect remained statistically significant . Major bleeding occurred in five ( 3 % ) of nadroparin-treated patients and in one ( 1 % ) of the placebo recipients ( P = .12 ) . In the a priori specified subgroup of patients with a life expectancy of 6 months or more at enrollment , the hazard ratio was 0.64 ( 95 % CI , 0.45 to 0.90 ) with a median survival of 15.4 and 9.4 months , respectively . For patients with a shorter life expectancy , the hazard ratio was 0.88 ( 95 % CI , 0.62 to 1.25 ) . CONCLUSION A brief course of subcutaneous low molecular weight heparin favorably influences the survival in patients with advanced malignancy and deserves additional clinical evaluation PURPOSE In experimental systems , interference with coagulation can affect tumor biology . Furthermore , it has been suggested that low molecular weight heparin therapy may prolong survival in patients with cancer . The primary aim of this study was to assess survival at 1 year of patients with advanced cancer . PATIENTS AND METHODS Patients with advanced malignancy ( N = 385 ) were r and omly assigned to receive either a once-daily subcutaneous injection of dalteparin ( 5,000 IU ) , a low molecular weight heparin , or placebo for 1 year . RESULTS The Kaplan-Meier survival estimates at 1 , 2 , and 3 years after r and omization for patients receiving dalteparin were 46 % , 27 % , and 21 % , respectively , compared with 41 % , 18 % , and 12 % , respectively , for patients receiving placebo ( P = .19 ) . In an analysis not specified a priori , survival was examined in a subgroup of patients ( dalteparin , n = 55 ; and placebo , n = 47 ) who had a better prognosis and who were alive 17 months after r and omization . In these patients , Kaplan-Meier survival estimates at 2 and 3 years from r and omization were significantly improved for patients receiving dalteparin versus placebo ( 78 % v 55 % and 60 % v 36 % , respectively , P = .03 ) . The rates of symptomatic venous thromboembolism were 2.4 % and 3.3 % for dalteparin and placebo , respectively , with bleeding rates of 4.7 % and 2.7 % , respectively . CONCLUSION Dalteparin administration did not significantly improve 1-year survival rates in patients with advanced malignancy . However , the observed improved survival in a subgroup of patients with a better prognosis suggests a potential modifying effect of dalteparin on tumor biology Gynecologic malignancies are often associated with deep vein thrombosis and pulmonary embolism , even before treatment is begun . But such complications also happen during treatment , also if thromboembolism prophylaxis is performed . The incidence of pulmonary embolism before treatment was investigated using scintigraphy . In a retrospective and in a prospect i ve r and omized trial , various methods of thromboembolism prophylaxis were evaluated during primary or postoperative radiation therapy . Pulmonary embolism was present in 11.9 % of the patients admitted with uterine malignancy . Retrospectively , there were deep vein thromboses in 6.8 % , pulmonary embolisms in 3.8 % and bleeding complications in 5.3 % of the patients receiving thromboembolism prophylaxis with acenocoumarol during radiation therapy of cervical and endometrial cancer . In the prospect i ve study , deep vein thromboses occurred in 1.5 % , pulmonary embolisms in 5.9 % and bleedings in 2.2 % , with both the LMW heparin and the acenocoumarol groups presenting similar results . Thromboembolism is a frequent paraneoplasia of uterine malignancies . The prevention of thromboembolic complications during radiation therapy of uterine malignancies is efficacious and safe using either LMW heparin or acenocoumarol Output:

Conclusion This review suggests a survival benefit of heparin in cancer patients in general , and in patients with limited small cell lung cancer in particular

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES This study sought to evaluate whether remote ischemic post-conditioning ( RIPC ) could reduce enzymatic infa rct size in patients with anterior ST-segment elevation myocardial infa rct ion undergoing primary percutaneous coronary intervention ( pPCI ) . BACKGROUND Myocardial reperfusion injury may attenuate the benefit of pPCI . In animal models , RIPC mitigates myocardial reperfusion injury . METHODS One hundred patients with anterior ST-segment elevation myocardial infa rct ion and occluded left anterior descending artery were r and omized to pPCI + RIPC ( n = 50 ) or conventional pPCI ( n = 50 ) . RIPC consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower limb . The primary endpoint was infa rct size assessed by the area under the curve of creatinine kinase-myocardial b and release ( CK-MB ) . Secondary endpoints included the following : infa rct size assessed by cardiac magnetic resonance delayed enhancement volume ; T2-weighted edema volume ; ST-segment resolution > 50 % ; TIMI ( Thrombolysis In Myocardial Infa rct ion ) frame count ; and myocardial blush grading . RESULTS Four patients ( 2 RIPC , 2 controls ) were excluded due to missing sample s of CK-MB . A total of 96 patients were analyzed ; median area under the curve CK-MB was 8,814 ( interquartile range [ IQR ] : 5,567 to 11,325 ) arbitrary units in the RIPC group and 10,065 ( IQR : 7,465 to 14,004 ) arbitrary units in control subjects ( relative reduction : 20 % , 95 % confidence interval : 0.2 % to 28.7 % ; p = 0.043 ) . Seventy-seven patients underwent a cardiac magnetic resonance scan 3 to 5 days after r and omization , and 66 patients repeated a second scan after 4 months . T2-weighted edema volume was 37 ± 16 cc in RIPC patients and 47 ± 22 cc in control subjects ( p = 0.049 ) . ST-segment resolution > 50 % was 66 % in RIPC and 37 % in control subjects ( p = 0.015 ) . We observed no significant differences in TIMI frame count , myocardial blush grading , and delayed enhancement volume . CONCLUSIONS In patients with anterior ST-segment elevation myocardial infa rct ion , RIPC at the time of pPCI reduced enzymatic infa rct size and was also associated with an improvement of T2-weighted edema volume and ST-segment resolution > 50 % . ( Remote Postconditioning in Patients With Acute Myocardial Infa rct ion Treated by Primary Percutaneous Coronary Intervention [ PCI ] [ RemPostCon ] ; NCT00865722 ) BACKGROUND Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty . We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infa rct ion , and done before primary percutaneous coronary intervention , increases myocardial salvage . METHODS 333 consecutive adult patients with a suspected first acute myocardial infa rct ion were r and omly assigned in a 1:1 ratio by computerised block r and omisation to receive primary percutaneous coronary intervention with ( n=166 patients ) versus without ( n=167 ) remote conditioning ( intermittent arm ischaemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff ) . Allocation was concealed with opaque sealed envelopes . Patients received remote conditioning during transport to hospital , and primary percutaneous coronary intervention in hospital . The primary endpoint was myocardial salvage index at 30 days after primary percutaneous coronary intervention , measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment ; analysis was per protocol . This study is registered with Clinical Trials.gov , number NCT00435266 . FINDINGS 82 patients were excluded on arrival at hospital because they did not meet inclusion criteria , 32 were lost to follow-up , and 77 did not complete the follow-up with data for salvage index . Median salvage index was 0.75 ( IQR 0.50 - 0.93 , n=73 ) in the remote conditioning group versus 0.55 ( 0.35 - 0.88 , n=69 ) in the control group , with median difference of 0.10 ( 95 % CI 0.01 - 0.22 ; p=0.0333 ) ; mean salvage index was 0.69 ( SD 0.27 ) versus 0.57 ( 0.26 ) , with mean difference of 0.12 ( 95 % CI 0.01 - 0.21 ; p=0.0333 ) . Major adverse coronary events were death ( n=3 per group ) , reinfa rct ion ( n=1 per group ) , and heart failure ( n=3 per group ) . INTERPRETATION Remote ischaemic conditioning before hospital admission increases myocardial salvage , and has a favourable safety profile . Our findings merit a larger trial to establish the effect of remote conditioning on clinical outcomes . FUNDING Fondation Leducq BACKGROUND Whether remote ischemic preconditioning ( transient ischemia and reperfusion of the arm ) can improve clinical outcomes in patients undergoing coronary-artery bypass graft ( CABG ) surgery is not known . We investigated this question in a r and omized trial . METHODS We conducted a multicenter , sham-controlled trial involving adults at increased surgical risk who were undergoing on-pump CABG ( with or without valve surgery ) with blood cardioplegia . After anesthesia induction and before surgical incision , patients were r and omly assigned to remote ischemic preconditioning ( four 5-minute inflations and deflations of a st and ard blood-pressure cuff on the upper arm ) or sham conditioning ( control group ) . Anesthetic management and perioperative care were not st and ardized . The combined primary end point was death from cardiovascular causes , nonfatal myocardial infa rct ion , coronary revascularization , or stroke , assessed 12 months after r and omization . RESULTS We enrolled a total of 1612 patients ( 811 in the control group and 801 in the ischemic-preconditioning group ) at 30 cardiac surgery centers in the United Kingdom . There was no significant difference in the cumulative incidence of the primary end point at 12 months between the patients in the remote ischemic preconditioning group and those in the control group ( 212 patients [ 26.5 % ] and 225 patients [ 27.7 % ] , respectively ; hazard ratio with ischemic preconditioning , 0.95 ; 95 % confidence interval , 0.79 to 1.15 ; P=0.58 ) . Furthermore , there were no significant between-group differences in either adverse events or the secondary end points of perioperative myocardial injury ( assessed on the basis of the area under the curve for the high-sensitivity assay of serum troponin T at 72 hours ) , inotrope score ( calculated from the maximum dose of the individual inotropic agents administered in the first 3 days after surgery ) , acute kidney injury , duration of stay in the intensive care unit and hospital , distance on the 6-minute walk test , and quality of life . CONCLUSIONS Remote ischemic preconditioning did not improve clinical outcomes in patients undergoing elective on-pump CABG with or without valve surgery . ( Funded by the Efficacy and Mechanism Evaluation Program [ a Medical Research Council and National Institute of Health Research partnership ] and the British Heart Foundation ; ERICCA Clinical Trials.gov number , NCT01247545 . ) Background : Two preconditioning stimuli should induce a more consistent overall cell protection . We hypothesized that remote ischemic preconditioning ( RIPC , second preconditioning stimulus ) applied during isoflurane inhalation ( first preconditioning stimulus ) would provide more protection to the myocardium of patients undergoing on-pump coronary artery bypass grafting . Methods : In this placebo-controlled r and omized controlled study , patients in the RIPC group received four 5-min cycles of 300 mmHg cuff inflation/deflation of the leg before aortic cross-clamping . Anesthesia consisted of opioids and propofol for induction and isoflurane for maintenance . The primary outcome was high-sensitivity cardiac troponin T release . Secondary endpoints were plasma levels of N-terminal pro-brain natriuretic peptide , high-sensitivity C-reactive protein , S100 protein , and short- and long-term clinical outcomes . Gene expression profiles were obtained from atrial tissue using microarrays . Results : RIPC ( n = 27 ) did not reduce high-sensitivity cardiac troponin T release when compared with placebo ( n = 28 ) . Likewise , N-terminal pro-brain natriuretic peptide , a marker of myocardial dysfunction ; high-sensitivity C-reactive protein , a marker of perioperative inflammatory response ; and S100 , a marker of cerebral injury , were not different between the groups . The incidence for the perioperative composite endpoint combining new arrhythmias and myocardial infa rct ions was higher in the RIPC group than the placebo group ( 14/27 vs. 6/28 , P = 0.036 ) . However , there was no difference in the 6-month cardiovascular outcome . N-terminal pro-brain natriuretic peptide release correlated with isoflurane-induced transcriptional changes in fatty-acid metabolism ( P = 0.001 ) and DNA-damage signaling ( P < 0.001 ) , but not with RIPC-induced changes in gene expression . Conclusions : RIPC applied during isoflurane inhalation provides no benefit to the myocardium of patients undergoing on-pump coronary artery bypass grafting BACKGROUND Clamping of the portal triad ( Pringle maneuver ) prevents blood loss during liver resection , but leads to liver injury upon reperfusion . Ischemic preconditioning ( IP ) has been shown to protect the liver against prolonged ischemic injury in animal models . However , the clinical value of this procedure has not yet been established . METHODS 61 Patients undergoing hepatic resection under inflow occlusion were r and omized to either to receive ( Group-A n = 30 ) or not to receive ( Group-B n = 31 ) an IP ( 10 minutes of ischemia followed 10 minutes of reperfusion ) . RESULTS Mean ( + /- SD)/ Group-A vs. Group-B. Pringle time of 34 + /- 14 and 33 + /- 12 minutes and the extent of resected liver tissue ( 2.7 + /- 1.3 vs. 2.7 + /- 1.1 segments ) were comparable in both groups . Complications , including death , severe liver dysfunction and biliary leakage occurred in 6 patients of Group-A vs. 14 patients of Group-B ( p<0.05 ) . Intraoperative blood loss was significantly lower in Group-A ( 1.28 + /- 0.91 l vs. 1.94 + /- 0.76 l ; p<0.001 ) with 5 vs. 15 patients requiring transfusions ( p<0.01 ) . In a multivariate analysis the duration of the Pringle maneuver ( p<0.05 ) and the absence of preconditioning ( p<0.05 ) were independent predictors for the occurrence of postoperative complications . CONCLUSIONS IP protects against reperfusion injury , reduces the incidence of complications after hepatic resection under inflow occlusion and is simple to use in clinical practice Background and Purpose — Remote ischemic preconditioning is neuroprotective in models of acute cerebral ischemia . We tested the effect of prehospital rPerC as an adjunct to treatment with intravenous alteplase in patients with acute ischemic stroke . Methods — Open-label blinded outcome proof-of-concept study of prehospital , paramedic-administered rPerC at a 1:1 ratio in consecutive patients with suspected acute stroke . After neurological examination and MRI , patients with verified stroke receiving alteplase treatment were included and received MRI at 24 hours and 1 month and clinical re-examination after 3 months . The primary end point was penumbral salvage , defined as the volume of the perfusion – diffusion mismatch not progressing to infa rct ion after 1 month . Results — Four hundred forty-three patients were r and omized after provisional consent , 247 received rPerC and 196 received st and ard treatment . Patients with a nonstroke diagnosis ( n=105 ) were excluded from further examinations . The remaining patients had transient ischemic attack ( n=58 ) , acute ischemic stroke ( n=240 ) , or hemorrhagic stroke ( n=37 ) . Transient ischemic attack was more frequent ( P=0.006 ) , and National Institutes of Health Stroke Scale score on admission was lower ( P=0.016 ) in the intervention group compared with controls . Penumbral salvage , final Output:

Ischaemic conditioning may reduce the rates of some secondary outcomes including stroke ( 18 trials ; 5995 participants ; 149 events ; risk ratio 0.72 , 0.52 to 1.00 ; P=0.048 ; very low quality evidence ) and acute kidney injury ( 36 trials ; 8493 participants ; 1443 events ; risk ratio 0.83 , 0.71 to 0.97 ; P=0.02 ; low quality evidence ) , although the benefits seem to be confined to non-surgical setting s and to mild episodes of acute kidney injury only . CONCLUSIONS Ischaemic conditioning has no overall effect on the risk of death . Possible effects on stroke and acute kidney injury are uncertain given method ological concerns and low event rates .

MS2_1shot563

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The benefits of preoperative biliary drainage , which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head , are unclear . METHODS In this multicenter , r and omized trial , we compared preoperative biliary drainage with surgery alone for patients with cancer of the pancreatic head . Patients with obstructive jaundice and a bilirubin level of 40 to 250 micromol per liter ( 2.3 to 14.6 mg per deciliter ) were r and omly assigned to undergo either preoperative biliary drainage for 4 to 6 weeks , followed by surgery , or surgery alone within 1 week after diagnosis . Preoperative biliary drainage was attempted primarily with the placement of an endoprosthesis by means of endoscopic retro grade cholangiopancreatography . The primary outcome was the rate of serious complications within 120 days after r and omization . RESULTS We enrolled 202 patients ; 96 were assigned to undergo early surgery and 106 to undergo preoperative biliary drainage ; 6 patients were excluded from the analysis . The rates of serious complications were 39 % ( 37 patients ) in the early-surgery group and 74 % ( 75 patients ) in the biliary-drainage group ( relative risk in the early-surgery group , 0.54 ; 95 % confidence interval [ CI ] , 0.41 to 0.71 ; P<0.001 ) . Preoperative biliary drainage was successful in 96 patients ( 94 % ) after one or more attempts , with complications in 47 patients ( 46 % ) . Surgery-related complications occurred in 35 patients ( 37 % ) in the early-surgery group and in 48 patients ( 47 % ) in the biliary-drainage group ( relative risk , 0.79 ; 95 % CI , 0.57 to 1.11 ; P=0.14 ) . Mortality and the length of hospital stay did not differ significantly between the two groups . CONCLUSIONS Routine preoperative biliary drainage in patients undergoing surgery for cancer of the pancreatic head increases the rate of complications . ( Current Controlled Trials number , IS RCT N31939699 . BACKGROUND A preoperative biliary stent is commonly used after the initial evaluation of the patient with a periampullary mass . OBJECTIVE To evaluate the effect of a preoperative biliary stent on operative difficulty , postoperative complications , and length of hospital stay after a pancreatoduodenectomy . DESIGN A retrospective review of a prospect ively collected consecutive series . SETTING The Memorial Sloan-Kettering Cancer Center 's Surgical Service , New York , NY . PATIENTS AND METHODS Seventy-four patients underwent pancreatoduodenectomy between March 1 , 1994 , and February 15 , 1996 . Thirty-five did not receive a biliary stent , and 39 received a biliary stent prior to medical evaluation . We analyzed patient , nutritional , laboratory , and operating room factors . Univariate analysis was by Student t test , chi2 test , and Fisher exact test ; multivariate analysis was by logistic regression . Significance was defined at P<.05 . MAIN OUTCOME MEASURES Operative time , amount of blood loss , complications , and length of hospital stay . Wound complications were defined as cellulitis , superficial infections , and deep infections . Intra-abdominal complications were defined as intra-abdominal abscesses and pancreatic or biliary fistula . RESULTS Groups were equivalent for tumor size , risk of comorbidity , time spent in the operating room , and amount of blood loss . There was 1 perioperative death . Patients with a stent had significantly lower bilirubin ( P<.03 ) and aspartate aminotransferase ( P<.04 ) levels and a significantly increased risk of nodal positivity ( P<.05 ) . The patients with a biliary stent had an increased risk of wound or abdominal complications on univariate ( P<.003 ) and multivariate ( P<.02 ) analysis and tended toward a prolonged hospital stay ( P<.04 , Wilcoxon signed rank test ) . CONCLUSIONS A preoperative biliary stent was associated with an increased risk of wound or intra-abdominal complications ; a stent may prolong the length of hospital stay . However , length of time under anesthesia , amount of blood loss , and transfusion requirements were not altered . A biliary stent should be used with a high degree of selectivity in the management of patients with resectable periampullary masses OBJECTIVE To find out factors that may influence the mortality after Whipple 's operation , whether duct to mucosa anastomosis is better than classic " dunking " pancreaticojejunostomy and whether age over 70 is a contraindication for this procedure . DESIGN Prospect ively r and omised study . SETTING Teaching hospital , Taiwan , R.O.C. PATIENTS 93 patients with periampullary cancer undergoing Whipple 's operation were r and omly divided into two groups . Forty-six with periampullary cancer underwent invaginating pancreaticojejunostomy , and 47 patients underwent duct to mucosa anastomosis for reconstruction . MAIN OUTCOME MEASURES Mortality and morbidity were compared between two groups . RESULTS The over all mortality was 8 % ( 7/93 ) . An albumin concentration of less than 30 g/L before operation and operative blood loss influenced the surgical mortality both in the univariate and multivariate analysis . Age over 70 years was not a factor . Patients with duct to mucosa anastomoses had a leak rate of 4 % ( 2/47 ) , morbidity of 21 % ( 10/47 ) and mortality of 6 % ( 3/47 ) . Patients with an invaginated pancreaticojejunostomy had a leak rate of 15 % ( 7/46 ) , morbidity of 33 % ( 15/46 ) , and mortality of 9 % ( 4/46 ) . The need for total parenteral nutrition in the invaginated group ( 33 % ) was statistically greater than in the other group ( 11 % ) ( p = 0.01 ) . CONCLUSIONS The morbidity and mortality of pancreaticoduodenectomy for periampullary cancer although slightly greater for patients over the age of 70 are acceptable . The factors that may influence the mortality are an albumin concentration of less then 30 g/L and the amount of blood lost during operation . The duct to mucosa anastomosis is a safe procedure , which has a lower leak rate and less need for total parenteral nutrition than pancreaticojejunostomy 57 patients with obstructive jaundice were r and omly allocated to surgery with preoperative external biliary drainage ( 29 patients ) and without preoperative external biliary drainage ( 28 patients ) . 22 patients ultimately underwent laparotomy after a mean of 11.7 days of drainage and 25 had surgery without preoperative drainage . The postoperative complication rate was low and similar in both groups but complications associated with the drainage procedure were substantial . Perioperative mortality was 4/28 ( 14 % ) in the drainage group and 4/27 ( 15 % ) in the non-drainage group . There seems to be no advantage associated with routine preoperative external biliary drainage before surgery for obstructive jaundice OBJECTIVE To analyze the morbidity and mortality after radical and palliative pancreatic cancer surgery in Norway , especially the risk factors . SUMMARY BACKGROUND DATA A prospect i ve multicenter study between 1984 - 1987 including only histologically or cytologically verified adenocarcinoma of the pancreas ( N = 442 ) or the papilla of Vater ( N = 30 ) ; 84 patients ( 19 % ) with pancreatic carcinoma and 24 patients ( 80 % ) with papilla carcinoma underwent radical operations . A palliative procedure was performed in 252 patients ( 53 % ) . METHODS Clinical data , surgical procedures and the following morbidity and mortality were recorded on st and ardized forms . The risk factors were analyzed by a logistic multiple regression model . RESULTS The morbidity , reoperation , and mortality rates were 43 , 18 , and 11 % after radical surgery and 23 , 4 , and 14 % after palliative surgery . Karnofsky 's index was the sole independent risk factor for death after radical surgery . Splenectomy , age , and TNM stage influenced morbidity . Diabetes , Karnofsky 's index , and liver metastases were risk factors in palliative surgery . CONCLUSIONS The morbidity and mortality risks were comparable between total pancreatectomy and a Whipple 's procedure and between biliary and a double bypass . Preoperative biliary drainage had no impact on the risks and may be ab and oned . High age is a relative and a low Karnofsky 's index an absolute contraindication for radical surgery . Nonsurgical palliation of jaundice should be considered according to the presence of independent risk factors BACKGROUND Patients with obstructive jaundice undergoing surgical procedures have a significant risk of morbidity and mortality . The role of preoperative percutaneous transhepatic biliary drainage ( PTBD ) was evaluated in a r and omized trial . METHODS A total of 40 patients were assigned to either preoperative PTBD ( n = 20 ) , or surgery alone ( n = 20 ) . PTBD was performed under ultrasound guidance . There were no major complications related to the procedure . RESULTS Ultrasound guided drainage was a successful and safe method of preoperative biliary decompression . There was a marked relief from pruritus and significant reduction of hyperbilirubinaemia from a mean of 386.48 mumol/L to 116.10 mumol/L ( p < 0.001 ) . Mean duration of drainage was 42.5 days . Postoperative complications occurred in five patients in PTBD group ( 25 % ) compared to 11 patients ( 55 % ) in the control group . One death ( 5 % ) occurred in PTBD group compared to four deaths ( 20 % ) in the control group ( significant at 5 % level with probability 0.2 ) . CONCLUSIONS Ultrasound guided drainage is a useful preoperative supportive measure in preparing deeply jaundiced patients for surgery and permits hepatic function to return to a near normal state preoperatively . The improved results in our study were due to longer duration of drainage Thirty patients with obstructive jaundice with plasma bilirubin values greater than 200 mumol/L were r and omized at the time of percutaneous transhepatic Cholangiography to undergo immediate or delayed surgery . The patients who had preoperative percutaneous transhepatic biliary drainage ( PTBD ) for 13.8 + /- 5.8 days had fewer surgical complications than did patients who underwent immediate surgery ( p less than 0.02 ) , although when the complications of PTBD were included this advantage was diminished . Immediate surgery caused greater deterioration of renal function as measured by plasma urea , plasma B 2-microglobulin , phosphate clearance , uric acid clearance , and maximal concentrating ability than occurred after PTBD or delayed surgery . The improvement in phosphate clearance that followed PTBD was sustained through delayed surgical treatment , indicating better tubular function in these patients . This article supports the concept that preoperative PTBD will reduce surgical morbidity and will result in less renal impairment than will immediate surgery . However , the morbidity rates of the PTBD procedure will preclude its wide use It has been suggested that the placement of endoscopic or percutaneous biliary stents prior to pancreaticoduodenectomy increases postoperative morbidity . A retrospective review of a prospect ively collected data base was performed . Patients undergoing preoperative biliary stenting were compared with patients who did not undergo stenting . In addition , outcomes after endoscopic and percutaneous stenting were compared . Patients who had undergone operative biliary bypass prior to pancreaticoduodenectomy were excluded from the analysis . Between January 1994 and December 1997,567 patients underwent pancreaticoduodenectomy without prior operative biliaty bypass . Preoperative biliary stenting was performed in 408 patients ( 72 % ) , whereas the remaining 159 patients ( 28 % ) did not undergo biliary stenting . In the stented group , 64 % had stents placed via a percutaneous approach and 36 % had stents placed endoscopically . The stented patients were older ( mean 63.1 years vs. 61.4 years ; P = 0.05 ) and were more likely to be white ( 92 % vs. 82 % ; P = 0.005 ) . Those who had stents placed were more likely to have jaundice ( 67 % vs. 38 % ; P < 0.0001 ) and fever ( 5 % vs. 1 % ; P = 0.03 ) as presenting symptoms . There were no differences in multiple intraoperative parameters when the two groups were compared . Patients who had stems placed had a perioperative mortality rate of 1.7 % compared to 2 Output:

Conclusions In patients with malignant biliary jaundice requiring surgery , PBD group had significantly less major adverse effects than DS group . Length of hospital stay and mortality rate were comparable in both the groups

MS2_1shot564

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The psychological response to breast cancer , such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease , has been suggested as a prognostic factor with an influence on survival . We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer . METHODS 578 women with early-stage breast cancer were enrolled in a prospect i ve survival study . Psychological response was measured by the mental adjustment to cancer ( MAC ) scale , the Courtauld emotional control ( CEC ) scale , and the hospital anxiety and depression ( HAD ) scale 4 - 12 weeks and 12 months after diagnosis . The women were followed up for at least 5 years . Cox 's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response , with adjustment for known clinical factors associated with survival . FINDINGS At 5 years , 395 women were alive and without relapse , 50 were alive with relapse , and 133 had died . There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression ( hazard ratio 3.59 [ 95 % CI 1.39 - 9.24 ] ) . There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category ( 1.55 [ 1.07 - 2.25 ] ) . There were no significant results found for the category of " fighting spirit " . INTERPRETATION For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect . A high score for depression is linked to a significantly reduced chance of survival ; however , this result is based on a small number of patients and should be interpreted with caution Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients . A double‐blind placebo‐controlled study was therefore design ed to assess the effectiveness of 20 mg fluoxetine . Of 115 cancer patients who fulfilled entry criteria for levels of distress , 45 patients were r and omized to a fluoxetine treatment group ( FA ) and 46 patients to a placebo group ( PA ) after a 1‐week placebo period design ed to exclude placebo responders . The Montgomery and Asberg Depression Scale ( MADRS ) , the Hamilton Anxiety Scale ( HAS ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Revised Symptom Checklist ( SCL90‐R ) and the Spitzer Quality of Life Index ( SQOLI ) were used to assess the efficacy of fluoxetine . The response rate , defined by a HADS score lower than 8 after 5 weeks of treatment , was not significantly higher in the FA group ( 11 % ) compared to the PA group ( 7 % ) . Compared to the PA group , patients in the FA group showed a significantly greater decrease in SCL90‐R mean total score after 5 weeks , but not a greater decrease in HADS mean score . No difference between the two groups was found in observer‐reported assessment s ( MADRS , HAS and SQOLI ) . Significantly more drop‐outs were observed in the FA group ( n=15 ) than in the PA group ( n=7 ) , although the frequencies of side‐effects were not significantly different Cancer patients diagnosed with solid tumors and undergoing a first course of chemotherapy were r and omized to either conventional care or a 10 contact 20 week cognitive behavioral intervention design ed to reduce emotional distress . Three hypotheses were tested . First , a test for a group effect found that patients in the intervention who entered the trial with higher symptom severity reported significantly lower depression at 10 but not 20 weeks . Patients in the experimental group who entered with higher depression were more depressed at 10 weeks than patients in the control group . The second hypothesis compared the intervention in two sub-indices of symptom severity ; one comprised of symptoms with a depressive component , the other of symptoms not associated with depression . The intervention was more effective in lowering depression at 10 weeks through an interaction with the non-depressive symptom sub-index . At 20 weeks , a significant main effect for the intervention on depression was observed . No interaction with either sub-index was observed . The third hypothesis found no main or interaction effect between psychotropic drugs and the intervention . In conclusion , behavioral interventions may influence depression differently over time . Initially , the intervention lowered depression through certain symptoms and only later did it effect depression directly . Symptoms with an affective component are relatively unaffected by the intervention which was independent of the presence of psychotropic medications Summary Background . Fatigue can significantly interfere with a cancer patient ’s ability to fulfill daily responsibilities and enjoy life . It commonly co-exists with depression in patients undergoing chemotherapy , suggesting that administration of an antidepressant that alleviates symptoms of depression could also reduce fatigue . Methods . We report on a double-blind clinical trial of 94 female breast cancer patients receiving at least four cycles of chemotherapy r and omly assigned to receive either 20 mg of the selective serotonin re-uptake inhibitor ( SSRI ) paroxetine ( Paxil ® , SmithKline Beecham Pharmaceuticals ) or an identical-appearing placebo . Patients began their study medication seven days following their first on- study treatment and continued until seven days following their fourth on- study treatment . Seven days after each treatment , participants completed question naires measuring fatigue ( Multidimensional Assessment of Fatigue , Profile of Mood States-Fatigue/Inertia subscale and Fatigue Symptom Checklist ) and depression ( Profile of Mood States-Depression subscale [ POMS-DD ] and Center for Epidemiologic Studies -Depression [ CES-D ] ) . Results . Repeated- measures ANOVAs , after controlling for baseline measures , showed that paroxetine was more effective than placebo in reducing depression during chemotherapy as measured by the CES-D ( p=0.006 ) and the POMS-DD ( p=0.07 ) but not in reducing fatigue ( all measures , ps > 0.27 ) . Conclusions . Although depression was significantly reduced in the 44 patients receiving paroxetine compared to the 50 patients receiving placebo , indicating that a biologically active dose was used , no significant differences between groups on any of the measures of fatigued were observed . Results suggest that modulation of serotonin may not be a primary mechanism of fatigue related to cancer treatment Abstract Objective : To determine the efficacy of adjuvant psychological therapy in patients with testicular cancer and to compare the characteristics and psychosocial outcomes of men who agreed to participate with those who declined to participate in a r and omised trial of psychological intervention . Design : Newly diagnosed patients were asked to participate in a r and omised trial of psychological support compared with st and ard medical care . Participants and non- participants completed self assessment question naires at baseline and at 2 , 4 and 12 months . Setting : Testicular Tumour Unit of the Royal Marsden Hospital . Subjects : 73 of 184 ( 40 % ) eligible patients agreed to enter the r and omised trial ( participants ) and 81 ( 44 % ) declined to participate but agreed to complete further assessment s ( non- participants ) . 30 patients wanted no further contact with the research ers . Outcome measures : Hospital anxiety and depression scale , psychosocial adjustment to illness scale , Rotterdam symptom checklist , mental adjustment to cancer scale . Only scores on the hospital anxiety and depression scale are reported for evaluating treatment efficacy . Results : 111 of 184 ( 60 % ) eligible men declined to participate in the trial . Patients with stage I disease were most likely to refuse to participate . A patient was less likely to participate if he had low volume disease and was receiving no further treatment . Likelihood of participation was associated with stage of disease and with type of primary treatment ( P<0.001 for heterogeneity ) . Patients with early stage disease ( P<0.001 ) and fewer physical symptoms ( P<0.001 ) were less likely to participate . Psychosocial factors associated with participation included anxious preoccupation regarding disease ( P=0.01 ) . There were no differences in outcome between participants and non- participants during follow up . Patients seemed to gain little benefit from adjuvant psychological therapy . At 2 months change from baseline favoured the treated group in the anxiety subscale ( mean difference between groups −1.41 ( 95 % confidence interval −2.86 to 0.03 ) ) . This was not sustained when adjusted for factors related to the disease . By 12 months change from baseline seemed to favour the control group ( mean difference between groups 1.66 ( −0.18 to 3.50 ) ) . Conclusions : Patients with testicular cancer seem to have considerable coping abilities . Those who declined to participate in the trial differed from those who participated . Those who agreed to participate may comprise the clinical group who perceive a need for psychological support . No evidence was found to indicate a need for routinely offering adjuvant psychological therapy . Key messages Counselling for patients with cancer is widely advocated , although its effectiveness has not been fully evaluated No study of patients with cancer has evaluated a psychological intervention in young men or in a group of patients with a disease with an excellent prognosis Most patients with testicular cancer declined to participate in this r and omised trial of adjuvant psychological therapy , and those who participated had more psychosocial dysfunction No evidence of benefit was observed after treatment with adjuvant psychological therapy in this group of patients There were no consistently significant differences in psychosocial outcome over one year between those who agreed to participate and those who declined to BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years . Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome Urinary and sexual dysfunctions are side effects of radical prostatectomy ( RP ) for prostate cancer ( PC ) that contribute to depression . Despite the effectiveness of support groups at reducing depression in cancer patients , men typically do not participate in them . The purpose of this pilot study was to test the effects of a dyadic intervention ( one-to-one support ) on social support ( Modified Inventory of Socially Supportive Behaviors ) , self-efficacy ( Stanford Inventory of Cancer Patient Adjustment ) , and depression ( Geriatric Depression Scale ) . Subjects were r and omized to group . Controls ( N=15 ; Mage=59.7 ) received usual care . Experimentals were paired with long-term survivors ( LTS ) who had RP and who had treatment side effects in common . Experimentals ( N=15 ; Mage=57.5 ) met with a LTS 8 times in 8 weeks to discuss concerns associated with survivorship . No significant differences were detected on social support , but after 4 weeks , significant differences were present on depression between controls and experimentals , however these differences were not seen at 8 weeks . After 8 weeks , there were also significant differences on self-efficacy between controls and experimentals . Weekly anecdotal data supported the feasibility and acceptance of the intervention that was a low cost strategy effective at reducing depression and increasing self-efficacy in men treated by RP . Future research directions and clinical application is presented Women with breast carcinoma commonly experience psychologic distress following their diagnosis . Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives . Web‐based breast cancer social support groups are widely used , but little is known of their effectiveness . Preliminary evidence suggests that women benefit from their participation in web‐based support groups Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention . Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and Output:

Contrary to previous review s that failed to distinguish between depressive symptoms and depression , this review found very little data from clinical trials ( without the possibility of confounding factors ) to demonstrate that psychotherapeutic interventions are effective in reducing depression in cancer patients . A number of small-scale , single-centre trials indicated that psychotherapeutic interventions ( especially cognitive behavioural therapy ) can have effects on depressive symptoms in cancer patients .

MS2_1shot565

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To implore the positive effects of endoscopic sinus surgery on the symptoms and quality of life ( QOL ) of patients with chronic rhinosinusitis ( CRS ) and their changing regularity of symptoms and QOL . METHODS A prospect i ve , r and omized and controlled trial was conducted to survey symptoms and QOL status of 120 CRS patients undergoing endoscopic sinus surgery , in contrast to that of 200 healthy individuals passing health examination , at the baseline and at 3- and 6-months postoperatively by visual analog score ( VAS ) symptom instrument and QOL instruments including medical outcome study short-form 36-items health survey ( SF-36 ) and sino-nasal outcome test-20 ( SNOT-20 ) . RESULTS In the 3 months follow-up setting s , total of individual symptom severity scores and global symptom severity scores of VAS , such domains as role physical and general health of SF-36 and total of the 20 items scores and the most important 5-item scores of SNOT-20 all began to get better markedly ( P < 0.05 ) ; in the 3 - 6 months follow-up setting s , the indices above stayed fixed ( P > 0.05 ) ; and in the 6-months follow-up setting s , indices of symptoms and QOL status entirely improved from the baseline , with SF-36 showing no scoring difference between CRS patients and healthy individuals , whereas VAS showed that abnormal nasal drainage and decreased sense of smell were still left and SNOT-20 showed that abnormal nasal drainage and lack of good sleep left , inferior to that of healthy objects significantly ( P < 0.05 ) . CONCLUSIONS On the whole CRS patients undergoing endoscopic sinus surgery recover symptomatically and come back to normal level of QOL status at the 6 months postoperatively , but such significant problems as abnormal nasal drainage , decreased sense of smell and lack of good sleep still remain and need to be treated Background Chronic rhinosinusitis ( CRS ) is a common disease that has a significant impact on quality of life ( QOL ) . The aim of this study was to evaluate the longer-term effects of combined medical and surgical therapy for CRS on overall health status and QOL . Methods We used a prospect i ve study that utilized the Short-Form 36 Survey at baseline presentation and at a mean time of 3 years post-functional endoscopic sinus surgery to assess the general health status of patients who presented for their initial visit from 1996 to 1998 . Of the 200 r and omly selected patients , 150 respondents completed follow-up surveys ( a 75 % response rate ) . Results Eighty-nine ( 59.3 % ) women and 61 ( 40.7 % ) men were included in the study . Baseline QOL scores indicated significant differences between patients with CRS and published norms in 6/8 subscale parameters ( role physical , bodily pain , general health , social function , vitality , and mental health ) . Significant improvement in all six categories was maintained at the end of the study period ( p < 0.05 ) with QOL scores within limits of published norms for the general population . Conclusion Our data indicate that functional endoscopic sinus surgery , combined with appropriate postoperative care , is effective at maintaining a significant improvement in the overall general health status of patients for at least 3 years after surgical intervention and that the overall scores return to a range of normative values for the general population OBJECTIVE The objective of this study was to determine if endoscopic sinus surgery ( ESS ) is effective in the management of chronic recurrent rhinosinusitis ( CRRS ) . METHODS A consecutive series of patients with CRRS diagnosed according to stringent criteria was prospect ively examined before and at least 1 year after ESS . Paranasal sinus computed tomography scans were staged and ESS was performed targeting radiographic disease and the ostiomeatal complex . Preoperative and postoperative disease severities in terms of symptom scores , medicine utilization , and re source factors were assessed using the rhinosinusitis symptom inventory ( RSI ) . Improvements in RSI symptom domains , medical and economic re source factors were determined using effect sizes and statistical comparison before and after ESS . RESULTS Nineteen patients ( mean age , 42.3 years ) completed the study with a mean follow up of 19.1 months . The mean Lund score was 3.42 ( st and ard deviation , 4.09 ) . Statistically significant decreases in nasal ( -36.1 ) , facial ( -28.4 ) , oropharyngeal ( -34.6 ) , systemic ( -24.7 ) , and total ( -31.9 ) RSI symptom domain scores were observed ( all P < .003 ) with effect sizes ranging from 0.87 to 1.63 ( strong surgical effect ) . Statistically significant decreases in antihistamine use ( -30 % , P = .031 ) , number of workdays missed as a result of CRRS ( -1.9 , P = .035 ) , and number of acute infectious episodes ( -2.5 , P = .006 ) were also observed . However , declines in weeks of antibiotic use ( -2.8 weeks , P = .293 ) and number of antibiotic courses ( -1.7 , P = .118 ) were not significant . CONCLUSIONS Patients with CRRS may substantially benefit both symptomatically and medically from ESS . Although surgery should be used cautiously in treating CRRS , further trials of ESS for CRRS are warranted BACKGROUND Chronic rhinosinusitis affects millions of North Americans and has been increasing annually since 1991 . This study aim ed to evaluate the effectiveness of functional endoscopic sinus surgery ( FESS ) done with the use of computer assistance ( CASS ) and without the use of computer assistance on patient quality of life . As of this writing , there is no published study that measures the difference in patient quality of life with and without image guidance in endoscopic sinus surgery . METHODS A nonr and omized prospect i ve study was performed on 95 patients . A 31-item quality of life ( Rhinosinusitis Outcome Measures Form [ RSOM-31 ] ) question naire was administered to patients prior to surgery and 6 months following surgery during a 3-year enrollment period . Patients assessed both rhinologic and nonrhinologic symptoms using a statistically vali date d scoring system . Statistical analysis was performed using both equal and unequal variance sample t-tests when appropriate . RESULTS Statistically significant improvement in mean score analysis between preoperative and postoperative results for all symptom subgroups was reported when the entire study population was included . When the improvement in quality of life was compared between the CASS and FESS surgical groups , the CASS group demonstrated an overall greater improvement in quality of life . CONCLUSION Quality of life restrictions in patients with chronic rhinosinusitis were greatest in the areas of nasal symptoms and sleep deprivation , which were significantly improved by endoscopic sinus surgery . Although the long-term effect of CASS as measured by patient quality of life remains relatively unknown , there appears to be a significant trend indicating greater quality of life improvement in the short- term over non-computer-assisted FESS techniques OBJECTIVE To evaluate the prevalence and severity of individual Rhinosinusitis Task Force ( RSTF ) symptoms in patients with chronic rhinosinusitis ( CRS ) undergoing functional endoscopic sinus surgery ( FESS ) . METHODS Retrospective analysis of prospect ively collected data in 201 patients treated with FESS . The prevalence and severity of individual RSTF major and minor symptom scores grade d on a visual analogue scale ( VAS ) were compared . Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed . RESULTS One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78 % . The average age was 49.4 ( range 18 - 80 ) with a male-to-female ratio of 1.1:1 . The preoperative leading mean symptom scores were postnasal drip ( 5.8 + /- 0.3 ) , nasal obstruction ( 5.7 + /- 0.3 ) , and facial congestion ( 5.1 + /- 0.3 ) . These symptoms were also the most prevalent with 82 % , 84 % , and 79 % of patients reporting these symptoms , respectively . Postoperative symptom improvements were significant ( P < .0001 ) across all RSTF domains except fever . The highest percentage improvement was seen with facial congestion ( 93 % ) , nasal obstruction ( 92 % ) , and postnasal drip ( 85 % ) . Multivariate analysis revealed significant ( P < .0001 ) high correlation between improvements of facial pain/pressure with facial congestion ( R = 0.72 ) , facial congestion with nasal obstruction ( R = 0.65 ) , and facial pain/pressure with headache ( R = 0.72 ) . CONCLUSION The top three RSTF symptoms were postnasal drip , nasal obstruction , and facial congestion in terms of prevalence and severity . Symptom scores improved after FESS . Of these symptoms , the degree of improvement of facial pain/pressure , facial congestion , nasal obstruction , and headache are highly correlated OBJECTIVES /HYPOTHESIS The objectives of this prospect i ve , double-blind diagnostic cohort study were to explore the relationship between patients ' reported symptoms of chronic rhinosinusitis ( CRS ) and radiographic findings in CRS to define clinical ly based diagnostic criteria for CRS and to determine a classification scheme that would allow for the accurate diagnosis of patients with CRS . METHODS A prospect i ve series of adult patients undergoing evaluation for potential chronic rhinosinusitis was studied . Patients ' symptoms were tabulated with the Rhinosinusitis Symptom Inventory ( RSI ) , which records symptoms associated with CRS on a Likert scale ( 5 = maximally severe ) . Medication and re source utilization were also tabulated . Scores for nasal , facial , oropharyngeal , systemic , and total symptom domains were computed ( 100 = maximum severity ) . Concurrent paranasal sinus computed tomography was obtained for each patient and scored according to the Lund-McKay system with review er blinding . Patients were classified as normal or representing true CRS according to previously published diagnostic radiographic criteria under two analyses . In analysis 1 , Lund scores < or = 1 were considered nondiseased and scores > or = 2 were considered as representing true CRS . In analysis 2 , Lund scores < or = 3 represented normal and scores > or = 4 represented true CRS . For each analysis , univariate statistics were computed to determine differences among patients ' reported symptoms with and without true CRS . Subsequently , classification analysis using classification regression trees was conducted to determine heuristics among clinical ly based criteria for the diagnosis of CRS . RESULTS Seven hundred three adult patients were enrolled ( mean age , 43.1 years ) . The most commonly reported symptoms in order of decreasing severity and presence were nasal obstruction , nasal congestion , discharge , fatigue , headache , facial pressure , and dysosmia , all with mean severity scores > or = 2.0 . Patients were previously treated for approximately 3 months each with topical nasal steroids , oral antihistamines , and oral antibiotics . Patients missed substantial workdays ( mean , 3.8/year ) and incurred significant physician visits ( mean , 3.5/year ) as a result of CRS . The nasal symptom domain exhibited the greatest severity ( 51.8 ) followed closely by the facial symptom domain ( 47.3 ) . According to the analysis 1 , 144 ( 20.5 % ) patients were classified as normal and 559 ( 79.5 % ) as true CRS . Only the presence of polyps ( P < .001 ) and dysosmia ( P = .008 ) distinguished between normal and diseased patients ; there were no significant differences between groups for the other symptoms and RSI domains . Classification analysis revealed that the presence of polyps , absence of dental pain , and low congestion/obstruction scores in the presence of dental pain predicted true CRS . Finally , a history of extended antibiotic courses before presentation also predicted true CRS . In the second analysis , 243 ( 34.6 % ) were normal versus 460 ( 65.4 % ) with true CRS . Only polyp presence and dysosmia exhibited statistically significant differences between normal and diseased patients ( P < .001 ) . The mean RSI nasal domain was higher for true patients with CRS ( P = .01 ) . Classification analysis identified polyp presence and dysosmia score > 2 effectively predicted CRS . Fatigue < or = 2 , discharge < or = 4 , and obstruction < or = 3 further predicted for CRS . Symptoms despite a > or = 5.5-week trial of nasal steroids also predicted CRS . Other major and minor symptoms , RSI domains , and re source factors failed to influence diagnostic classification . CONCLUSIONS The diagnosis of CRS based on symptom criteria is difficult because most symptoms ( other than dysosmia ) do not distinguish between radiographically normal and diseased patients . A classification scheme for CRS based on the presence or absence of polyps is valid . It is possible to classify patients with true CRS based on symptoms , but this requires complicated heuristics . Corroborating radiographic evidence should be required to establish the diagnosis of CRS before long periods of therapy or surgical intervention OBJECTIVE To determine whether preoperative computed tomography ( CT ) stage predicts degree of symptom improvement after endoscopic sinus surgery ( ESS ) . METHODS A series of adult patients undergoing ESS was prospect ively evaluated with CT and the rhinosinusitis symptom inventory ( RSI ) preoperatively and at a minimum of 12 months postoperatively . Symptom domains ( nasal , facial , oropharyngeal , systemic , and total ) were computed and both Output:

Preoperative fatigue severity scores and improvement noted after surgery were similar to the respective values for other pooled CRS symptoms

MS2_1shot566

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: UNLABELLED The effects of intravascular volume replacement regimens on tissue oxygen tension ( ptiO(2 ) ) are not definitely known . Forty-two consecutive patients scheduled for elective major abdominal surgery were prospect ively r and omized to receive either 6 % hydroxyethyl starch ( HES ) ( mean molecular weight 130 kd , degree of substitution 0.4 , n = 21 ) or lactated Ringer 's solution ( RL , n = 21 ) for intravascular volume replacement . Fluids were administered perioperatively and continued for 24 h on the intensive care unit to keep central venous pressure between 8 and 12 mm Hg . The ptiO(2 ) was measured continuously in the left deltoid muscle by using microsensoric implantable partial pressure of oxygen catheters after the induction of anesthesia ( baseline , T0 ) , 60 min ( T1 ) and 120 min thereafter ( T2 ) , at the end of surgery ( T3 ) , and on the morning of the first postoperative day on the intensive care unit ( T4 ) . HES 130/0.4 2920 + /- 360 mL and 11,740 + /- 2,630 mL of RL were given to the patients within the study period . Systemic hemodynamics and oxygenation ( PaO(2 ) , PaCO(2 ) ) did not differ significantly between the two volume groups throughout the study . From similar baseline values , ptiO(2 ) increased significantly in the HES-treated patients ( a maximum of 59 % at T4 ) , whereas it decreased in the RL group ( a maximum of -23 % at T4 , P < 0.05 ) . The largest differences of ptiO(2 ) were measured on the morning of the first postoperative day . We conclude that intravascular volume replacement with 6 % HES 130/0.4 improved tissue oxygenation during and after major surgical procedures compared with a crystalloid-based volume replacement strategy . Improved microperfusion and less endothelial swelling may be responsible for the increase in ptiO(2 ) in the HES 130/0.4-treated patients . IMPLICATION S In patients undergoing major abdominal surgery , a colloid-based ( with hydroxyethyl starch [ HES ] 130/0.4 ) and a crystalloid-based ( with lactated Ringer 's solution [ RL ] ) volume replacement regimen was compared regarding tissue oxygen tension ( ptiO(2 ) ) measured continuously by microsensoric implantable catheters . The ptiO(2 ) increased in the HES-treated ( + 59 % ) but decreased in the RL-treated ( -23 % ) patients . Improved microcirculation may be the mechanism for the better ptiO(2 ) in the HES group Objective Both albumin and synthetic colloids such as hydroxyethyl starch ( HES ) solution are used to optimize hemodynamics in the critically ill . The influence of different long-term infusion regimes on platelet function was studied . Design Prospect i ve , r and omized study . Setting Clinical investigation on a university hospital surgical intensive care unit . Patients Twenty-eight consecutive trauma patients ( injury severity score>15 points ) and 28 consecutive nontraumatized surgical patients with sepsis . Interventions The patients received either 20 % human albumin ( HA trauma , n=14 ; HA sepsis , n=14 ) or 10 % low-molecular-weight HES solution HES 200/0.5 ( HES trauma , n=14 ; HES sepsis;n=14 ) for 5 days to maintain central venous pressure and /or pulmonary capillary wedge pressure between 12 and 16 mmHg . Measurements and results Platelet function was assessed by aggregometry ( = turbidimetric technique ) using adenosine diphosphate 2.0 μmol/l , collagen 4 μl/ml , and epinephrine 25 μmol/l as inductors . Arterial blood was sample d on the day of admission or the day of diagnosis of sepsis ( = baseline value ) and over the next 5 days . St and ard coagulation parameters ( antithrombin III , fibrinogen , partial thromboplastin time ) were also measured . Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients ( HA trauma : 1850±380 ml ; HA sepsis : 1790±400 ml ) . Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups . At the end of the investigation period , platelet aggregation variables had recovered and reached ( or even exceeded ) baseline values . Within the entire investigation period , the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients . Conclusions Alterations in hemostasis may occur for several reasons in the critically ill . Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders . With respect to platelet function , volume replacement with ( lower-priced ) low-molecular-weight HES solutions can be recommended in this situation without any risk BACKGROUND It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units ( ICUs ) affects survival . We conducted a multicenter , r and omized , double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU . METHODS We r and omly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days . The primary outcome measure was death from any cause during the 28-day period after r and omization . RESULTS Of the 6997 patients who underwent r and omization , 3497 were assigned to receive albumin and 3500 to receive saline ; the two groups had similar baseline characteristics . There were 726 deaths in the albumin group , as compared with 729 deaths in the saline group ( relative risk of death , 0.99 ; 95 percent confidence interval , 0.91 to 1.09 ; P=0.87 ) . The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups ( P=0.85 ) . There were no significant differences between the groups in the mean ( + /-SD ) numbers of days spent in the ICU ( 6.5+/-6.6 in the albumin group and 6.2+/-6.2 in the saline group , P=0.44 ) , days spent in the hospital ( 15.3+/-9.6 and 15.6+/-9.6 , respectively ; P=0.30 ) , days of mechanical ventilation ( 4.5+/-6.1 and 4.3+/-5.7 , respectively ; P=0.74 ) , or days of renal-replacement therapy ( 0.5+/-2.3 and 0.4+/-2.0 , respectively ; P=0.41 ) . CONCLUSIONS In patients in the ICU , use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days BACKGROUND The role of intensive insulin therapy in patients with severe sepsis is uncertain . Fluid resuscitation improves survival among patients with septic shock , but evidence is lacking to support the choice of either crystalloids or colloids . METHODS In a multicenter , two-by-two factorial trial , we r and omly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10 % pentastarch , a low-molecular-weight hydroxyethyl starch ( HES 200/0.5 ) , or modified Ringer 's lactate for fluid resuscitation . The rate of death at 28 days and the mean score for organ failure were co primary end points . RESULTS The trial was stopped early for safety reasons . Among 537 patients who could be evaluated , the mean morning blood glucose level was lower in the intensive-therapy group ( 112 mg per deciliter [ 6.2 mmol per liter ] ) than in the conventional-therapy group ( 151 mg per deciliter [ 8.4 mmol per liter ] , P<0.001 ) . However , at 28 days , there was no significant difference between the two groups in the rate of death or the mean score for organ failure . The rate of severe hypoglycemia ( glucose level , < or = 40 mg per deciliter [ 2.2 mmol per liter ] ) was higher in the intensive-therapy group than in the conventional-therapy group ( 17.0 % vs. 4.1 % , P<0.001 ) , as was the rate of serious adverse events ( 10.9 % vs. 5.2 % , P=0.01 ) . HES therapy was associated with higher rates of acute renal failure and renal-replacement therapy than was Ringer 's lactate . CONCLUSIONS The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia . As used in this study , HES was harmful , and its toxicity increased with accumulating doses . ( Clinical Trials.gov number , NCT00135473 . Objective There is continuing concern on the influence of hydroxethyl starch ( HES ) on renal function . Design Prospect i ve , r and omized study . Setting University-affiliated medical center . Patients Forty consecutive patients aged > 70 years undergoing cardiac surgery using cardiopulmonary bypass . Interventions Either low-molecular HES ( mean molecular weight : 130 kD ) with low degree of substitution ( 0.4 ) ( 6 % HES 130/0.4 ) ( n=20 ) or gelatin ( n=20 ) was given after induction of anesthesia until the 2nd postoperative day ( POD ) to keep central venous pressure between 12–14 mmHg . Measurements and results Creatinine clearance ( CC ) and fractional sodium clearance ( FSC ) were measured . N-acetyl-beta-D-glucosamidase , alpha-1-microglobulin , glutathione transferase-pi , and glutathione transferase-alpha were measured from urine specimens . Measurements were made after induction of anesthesia , at the end of surgery , and at the first and the second POD . More gelatin ( total : 4150±490 ml ) than HES 130/0.4 ( total : 3450±450 ml ) was infused within the study . CC and FSC were without differences between the two groups . All measured kidney-specific proteins were almost within normal range at baseline . They increased significantly after surgery , however , without significant group differences . At the 2nd POD , kidney-specific proteins had returned almost to normal values . None of the patients developed acute renal failure . Conclusions Sensitive markers of kidney dysfunction increased in our elderly patients indicating moderate alterations in kidney integrity during cardiac surgery . The two volume replacement regimens did not differ with regard to kidney integrity in elderly patients undergoing cardiac surgery Various vasoactive substances are involved in the regulation of the macro- and microcirculation . We have investigated if these regulators change during long-term volume therapy with human albumin ( HA ) or hydroxyethylstarch solution ( HES ) in trauma and sepsis patients . To maintain pulmonary capillary wedge pressure ( PCWP ) at 10 - 15 mm Hg , either 20 % HA ( HA-trauma , n = 14 ; HA-sepsis , n = 14 ) or 10 % low-molecular weight HES solution ( HES-trauma , n = 14 ; HES-sepsis , n = 14 ) were infused for 5 days , otherwise patient management did not differ between the two groups ( trauma/sepsis ) . Mean arterial pressure ( MAP ) , heart rate ( HR ) , PCWP and cardiac index ( CI ) were monitored in all patients . Liver function was assessed using the monoethylglycinexylidide ( MEGX ) test , and gastric intramucosal pH ( pHi ) was monitored by tonometry to assess splanchnic perfusion . Plasma concentrations of vasopressin , endothelin-1 , adrenaline , noradrenaline , atrial natriuretic peptide and 6-keto-prostagl and in F1 alpha were measured from arterial blood sample s. All measurements were carried out on the day of admission to the intensive care unit ( trauma patients ) or on diagnosis of sepsis , and daily over the next 5 days at 12:00 . MAP , HR and PCWP did not differ between the corresponding subgroups ( trauma/sepsis ) . Cl increased significantly more in the HES than in the HA groups . pHi and MEGX plasma concentrations did not differ in the trauma patients throughout the study . Both were lower than normal in the sepsis groups and increased more markedly in the HES than in the albumin-treated patients ( P < 0.05 ) . In the trauma patients , concentrations of all vasoactive regulators were very similar in both groups . In both sepsis groups , vasopressors ( vasopressin , endothelin-1 , noradrenaline and adrenaline ) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients . Concentrations of atrial natriuretic peptide increased only in the HA patients ( from 159 ( Output:

A recent systematic review and meta analysis from the Canadian Critical Care Trials Group concluded that critically ill patients receiving HES were more likely to receive renal replacement therapy , and identified a trend toward increased risk of death in association with HES for patients with severe sepsis .

MS2_1shot567

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The relative value of chest physiotherapy ( including cough ) and cough alone for the removal of excessive tracheobronchial secretions has been assessed in six patients with stable chronic obstructive lung disease . After labelling with inhaled radioactive tracer particles , clearance of secretions from selected central and peripheral lung regions was followed with a gamma camera linked to a computer . Cough alone and chest physiotherapy ( including cough ) were equally effective in the enhancement of central lung clearance . Physiotherapy but not cough along accelerated peripheral lung clearance ( p less than 0.05 ) . Sputum yield was greater during physiotherapy than during cough ( p less than 0.05 ) . These findings confirm the value of chest physiotherapy and high-light the limitation of cough in patients with excessive tracheobronchial secretion and impaired mucociliary clearance BACKGROUND Bronchiectasis is a chronic suppurative lung disease characterised by irreversible dilation of the bronchi and persistent purulent sputum . The immunopathology of the disease was studied using a quantitative immunostaining technique with particular reference to T lymphocytes , macrophages , and granulocytes . METHODS Bronchial mucosal biopsy specimens were obtained by fibreoptic bronchoscopy from 12 patients with bronchiectasis ( six receiving inhaled steroids ) and 11 normal healthy controls . Immunostaining ( APAAP method ) was performed on frozen cryostat sections with a panel of monoclonal antibodies to total leucocytes ( CD45 ) , T lymphocyte phenotypic markers ( CD3 , CD4 , CD8 ) , macrophages ( CD68 ) , eosinophils ( EG2 ) , and neutrophils ( elastase ) . RESULTS There was a mononuclear cell infiltrate in both patients with bronchiectasis and normal controls , but an overall increase in total leucocyte cell numbers ( CD45 + cells ) was identified in those with bronchiectasis ( median values 422 cells/mm2 versus 113 cells/mm2 in control tissue , p<0.001 ) . Intense infiltration of CD3 + T lymphocytes was observed compared with healthy controls ( 292 cells/mm2 and 40 cells/mm2 , respectively , p<0.001 ) . This comprised predominantly CD4 + T cells ( 118 cells/mm2 ) rather than CD8 + T cells ( 47 cells/mm2 ) . CD3 + cell counts were reduced in those subjects on inhaled steroids compared with those not receiving inhaled steroids ( 197 cells/mm2 versus 369 cells/mm2 , p<0.05 ) , as were CD4 + cell counts ( 82 cells/mm2 versus 190 cells/mm2 , p<0.05 ) . Neutrophil and macrophage cell numbers were also increased in patients with bronchiectasis ( 114 cells/mm2 and 213 cells/mm2 , respectively ) compared with controls ( 41 neutrophils/mm2 and 40 macrophages/mm2 ) . EG2 + ( activated ) eosinophil numbers were much lower than T cells , macrophages , and neutrophils in patients with bronchiectasis but were increased compared with controls ( 36 cells/mm2 versus 0 cells/mm2 , p<0.001 ) . In view of the markedly increased neutrophil counts in patients with bronchiectasis , biopsy specimens were immunostained for interleukin 8 ( IL-8 ) which was highly significantly increased compared with controls ( 47 cells/mm2 versus 15 cells/mm2 , p<0.01 ) . IL-8 + cells were less prominent in steroid treated patients than in patients not receiving treatment ( 30 cells/mm2 versus 60 cells/mm2 , p<0.05 ) . A further characteristic of bronchiectasis was mucous gl and hypertrophy . Gl and area comprised up to 40 % of the tissue in some bronchiectasis sections while no hypertrophy was noted in control biopsy specimens ( p<0.05 ) . CONCLUSION Airway inflammation in bronchiectasis is characterised by tissue neutrophilia , a mononuclear cell infiltrate composed mainly of CD4 + T cells and CD68 + macrophages , and increased IL-8 expression . Inhaled corticosteroid treatment in patients with bronchiectasis is associated with a less marked infiltration by T cells and IL-8 + cells within the bronchial mucosa , although this finding requires confirmation in a prospect i ve placebo controlled trial Eight patients with Young 's syndrome were treated with four " mucoregulatory " agents for eight weeks in a r and omised , open crossover study . There was no improvement in tracheobronchial clearance , pulmonary function , or sperm count Background Non-cystic fibrosis bronchiectasis is characterised by sputum production , exercise limitation and recurrent infections . Although pulmonary rehabilitation is advocated for this patient group , its effects are unclear . The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity , cough , quality of life and the incidence of acute pulmonary exacerbations . Methods / Design This r and omised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions . Participants will be r and omly allocated to the intervention group ( supervised , twice weekly exercise training with regular review of airway clearance therapy ) or a control group ( twice weekly telephone support ) . Measurements will be taken at baseline , immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor . Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test . Quality of life and health status will be measured using the Chronic Respiratory Question naire , Leicester Cough Question naire , Assessment of Quality of Life Question naire and the Hospital Anxiety and Depression Scale . The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary . Discussion Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population .Trial registration This study protocol is registered with Clinical Trials.gov ( NCT00885521 ) BACKGROUND AND PURPOSE Although the application of airway clearance techniques is considered an important component in the treatment of several obstructive pulmonary diseases , there is no scientific evidence supporting the use of Flutter Valve ™ in the management of patients with bronchiectasis . Moreover , the consequences of respiratory physiotherapy techniques on respiratory mechanics have not been fully studied . Therefore , we investigated the acute , short-term effects of Flutter Valve ™ on respiratory mechanics and sputum production in bronchiectatic patients . METHODS EIGHT patients were evaluated in a r and omized , blinded , cross-over trial . Impedance at 5 Hz ( R5 ) , resistance as a function of oscillation frequency ( dR/dF ) , reactance at 5 Hz ( X5 ) , resonant frequency ( f(0 ) ) and integral of reactance between 5 Hz and resonant frequency ( AX ) were recorded . RESULTS Flutter Valve ™ cleared 8.4 mL more secretions than the Sham Flutter intervention ( 95 % confidence interval [ 95 % CI ] , 3.4 - 13.4 ) . There was a higher percentage decrease in R5 ( -11.2 % ; 95 % CI , -4.4 to -18.2 ) , dR/dF ( -20.8 % ; 95 % CI , -32.4 to -9 ) and AX ( -7.8 % ; 95 % CI , -11.9 to -3.7 ) under Flutter Valve ™ . X5 and f(0 ) variation did not differ between interventions . CONCLUSIONS Flutter Valve ™ increases sputum removal during treatment and diminishes total and peripheral airway resistance in hypersecretive patients with bronchiectasis . Impulse oscillometry is a user-friendly tool to evaluate the effects of airway clearance techniques on respiratory mechanics BACKGROUND --In vitro studies have suggested that both the viscoelastic properties of lung secretions and the peak flow attained during simulated cough influence clearance . This study examines the possible association of the viscoelastic properties of sputum and maximum expiratory flow with measured effectiveness of mucus clearance induced by instructed cough and by forced expiration technique ( FET ) in patients with airways obstruction . METHODS --Nineteen patients ( 11 men and eight women ) of mean ( SE ) age , % predicted FEV1 , and daily sputum wet weight of 64 ( 2 ) years , 52 (6)% , and 37.5 ( 7.9 ) g respectively participated in the study . Mucus movement from proximal and peripheral lung regions was measured by an objective non-invasive radioaerosol technique . Each patient underwent three assessment s : control , cough , and FET . During cough and FET , maximum expiratory flow was measured at the mouth level . Apparent viscosity and elasticity of the expectorated sputum sample s were measured with a viscometer . RESULTS --Compared with the control run ( mean ( SE ) clearance : 16 (3)% ) there was an increase in clearance from the whole lung during cough ( 44 (5)% ) and FET ( 42 (5)% ) , and also an enhanced clearance of inhaled , deposited radioaerosol from the trachea , inner and intermediate regions of the lungs , but not from the outer region . There were , however , no differences in regional clearance between cough and FET . Neither regional nor total clearance correlated with maximum expiratory flow , apparent viscosity , elasticity , or daily sputum wet weight . CONCLUSIONS --These results confirm that cough and FET both promote effective clearance but suggest that , unlike in vitro studies , sputum production and viscoelasticity , as well as maximum expiratory flow , provide no guide to clearance efficacy in humans Background : Bronchiectasis is a chronic suppurative lung disease often characterised by airflow obstruction and hyperinflation , and leading to decreased exercise tolerance and reduced health status . The role of pulmonary rehabilitation ( PR ) and inspiratory muscle training ( IMT ) has not been investigated in this group of patients . Methods : Thirty two patients with idiopathic bronchiectasis were r and omly allocated to one of three groups : PR plus sham IMT ( PR-SHAM ) , PR plus targeted IMT ( PR-IMT ) , or control . All patients ( except the control group ) underwent an 8 week training programme of either PR or PR plus targeted IMT . Exercise training during PR was performed three times weekly at 80 % of the peak heart rate . IMT was performed at home for 15 minutes twice daily over the 8 week period . Results : PR-SHAM and PR-IMT result ed in significant increases in the incremental shuttle walking test of 96.7 metres ( 95 % confidence interval ( CI ) 59.6 to 133.7 ) and 124.5 metres ( 95 % CI 63.2 to 185.9 ) , respectively , and in endurance exercise capacity of 174.9 % ( 95 % CI 34.7 to 426.1 ) and 205.7 % ( 95 % CI 31.6 to 310.6 ) . There were no statistically significant differences in the improvements in exercise between the two groups . Significant improvements in inspiratory muscle strength were also observed both in the PR-IMT group ( 21.4 cm H2O increase , 95 % CI 9.3 to 33.4 ; p = 0.008 ) and the PR-SHAM group ( 12.0 cm H2O increase , 95 % CI 1.1 to 22.9 ; p = 0.04 ) , the magnitude of which were also similar ( p = 0.220 ) . Improvements in exercise capacity were maintained in the PR-IMT group 3 months after training , but not in the PR-SHAM group . Conclusion : PR is effective in improving exercise tolerance in bronchiectasis but there is no additional advantage of simultaneous IMT . IMT may , however , be important in the longevity of the training effects Educational aims To describe the specific current and potential future treatments for bronchiectasis . To describe a potential management plan for the treatment of bronchiectasis . Summary Non-cystic fibrosis ( non-CF ) bronchiectasis remains a common and difficult respiratory condition to manage . Patients with bronchiectasis generally tend to have persistent symptoms and require long-term medical treatment . There are a large number of treatment options available for the management of bronchiectasis . However only a limited number of trials to assess efficacy of treatment have been conducted . These studies have generally included fewer than 20 patients and very few of them have been r and omised or blinded . As such , the management of bronchiectasis is not clearly defined . This review will discuss the specific treatments available to treat patients with non-CF bronchiectasis and how they could be integrated into a specific management plan AUTHOR : e-mail address please Background : Airway clearance techniques are an important part of the routine care of patients with bronchiectasis . The use of the Flutter , a h and held pipe-like device causing oscillating positive expiratory pressure within the airways , has been proposed as an alternative to more conventional airway clearance techniques . Methods : A r and omised crossover study was performed in 17 stable patients with non-cystic fibrosis bronchiectasis at home , in which 4 weeks of daily active cycle of breathing technique ( ACBT ) were compared with 4 Output:

AUTHORS ' CONCLUSIONS ACTs appear to be safe for individuals ( adults and children ) with stable bronchiectasis , where there may be improvements in sputum expectoration , selected measures of lung function and health-related quality of life . The role of these techniques in people with an acute exacerbation of bronchiectasis is unknown .

MS2_1shot568

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIM To investigate the effect of low central venous pressure ( LCVP ) on blood loss during hepatectomy for hepatocellular carcinoma ( HCC ) . METHODS By the method of sealed envelope , 50 HCC patients were r and omized into LCVP group ( n=25 ) and control group ( n=25 ) . In LCVP group , CVP was maintained at 2 - 4 mmHg and systolic blood pressure ( SBP ) above 90 mmHg by manipulation of the patient 's posture and administration of drugs during hepatectomy , while in control group hepatectomy was performed routinely without lowering CVP . The patients ' preoperative conditions , volume of blood loss during hepatectomy , volume of blood transfusion , length of hospital stay , changes in hepatic and renal functions were compared between the two groups . RESULTS There were no significant differences in patients ' preoperative conditions , maximal tumor dimension , pattern of hepatectomy , duration of vascular occlusion , operation time , weight of resected liver tissues , incidence of post-operative complications , hepatic and renal functions between the two groups . LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group , being 903.9+/-180.8 mL vs 2 329.4+/-2 538.4 ( W=495.5 , P<0.01 ) and 672.4+/-429.9 mL vs 1 662.6+/-1 932.1 ( W=543.5 , P<0.01 ) . There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups . The length of hospital stay was significantly shortened in LCVP group as compared with the control group , being 16.3+/-6.8 d vs 21.5+/-8.6 d ( W=532.5 , P<0.05 ) . CONCLUSION LCVP is easily achievable in technique . Maintenance of CVP < or= 4 mmHg can help reduce blood loss during hepatectomy , shorten the length of hospital stay , and has no detrimental effects on hepatic or renal function Objective : To evaluate the protective effects of ischemic preconditioning in a prospect i ve r and omized study involving a large population of unselected patients and to identify factors affecting the protective effects . Summary Background Data : Ischemic preconditioning is an effective protective strategy in several animal models . Protection has also been suggested in a small series of patients undergoing a hemihepatectomy with 30 minutes of inflow occlusion . Whether preconditioning confers protection in other types of liver resection and longer periods of ischemia is unknown . Therefore , we conducted a prospect i ve r and omized study to evaluate the impact of ischemic preconditioning in liver surgery . Methods : A total of 100 unselected patients undergoing major liver resection ( > bisegmentectomy ) under inflow occlusion for at least 30 minutes were r and omized during surgery to either receive or not receive an ischemic preconditioning protocol ( 10 minutes of ischemia followed by 10 minutes of reperfusion ) . Univariate and multivariate analyses were performed to identify independent factors affecting the protective effects of ischemic preconditioning . ATP contents in liver were measured as a possible mechanism of protection . Results : Both groups ( n = 50 in each ) were comparable regarding age , gender , duration of inflow occlusion , and resected liver volumes . Postoperative serum transaminase levels were significantly lower in preconditioned than in control patients ( median peak AST 364 U/L vs. 520 U/L , P = 0.028 ; ALT 406 vs. 519 U/L , P = 0.049 ) . Regression multivariate analysis revealed an increased benefit of ischemic preconditioning in younger patients , in patients with longer duration of inflow occlusion ( up to 60 minutes ) , and in cases of lower resected liver volume ( < 50 % ) . Patients with steatosis were also particularly protected by ischemic preconditioning . ATP content in liver tissue was preserved by ischemic preconditioning in young but not older patients . Conclusions : This study establishes ischemic preconditioning as a protective strategy against hepatic ischemia in humans . The strategy is particularly effective in young patients requiring a prolonged period of inflow occlusion , and in the presence of steatosis , and is possibly related to preservation of ATP content in liver tissue . Other strategies are needed in older patients Objective This prospect i ve r and omized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection . Summary Background Data Routine drainage is no longer advocated after several intra-abdominal surgical procedures . Methods A series of 81 patients who underwent elective hepatic resection were r and omly allocated to either a nondrainage group ( n = 39 ) and a drainage group with closed-suction drainage ( n = 42 ) . Indications for resection were 42 benign lesions and 39 malignant tumors , including 19 with cirrhosis . Major hepatic resection was performed in 25 patients and minor resection , in 56 . All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collection s within the first 5 postoperative days . Results One patient died in each group . Ultrasonography found a significantly higher rate of subphrenic collection s in the drainage group compared with the nondrainage group ( respectively , 36 % vs. 15 % , p < 0.05 ) . These collection s were more frequently infected in the drainage group ( n = 6 ) than in the nondrainage group ( n = 2 ) . After major liver resection , the rate of intra-abdominal postoperative complications ( i.e. , subphrenic fluid collection s , hematomas , and bilomas ) was similar between the two groups . Conclusion Minor liver resection is safer without drainage . Major liver resection can be performed with or without abdominal drainage BACKGROUND Two r and omized prospect i ve studies suggested that ischemic preconditioning ( IP ) protects the human liver against ischemia-reperfusion injury after hepatectomy performed under continuous clamping of the portal triad . The primary goal of this study was to determine whether IP protects the human liver against ischemia-reperfusion injury after hepatectomy under continuous vascular exclusion with preservation of the caval flow . STUDY DESIGN Sixty patients were r and omly divided into two groups : with ( n=30 ; preconditioning group ) and without ( n=30 ; control group ) IP ( 10 minutes of portal triad clamping and 10 minutes of reperfusion ) before major hepatectomy under vascular exclusion of the liver preserving the caval flow . Serum concentrations of aspartate transferase , alanine transferase , glutathione-S-transferase , and bilirubin and prothrombin time were regularly determined until discharge and at 1 month . Morbidity and mortality were determined in both groups . RESULTS Peak postoperative concentrations of aspartate transferase were similar in the groups with and without IP ( 851 + /- 1,733 IU/L and 427 + /- 166 IU/L respectively , p=0.2 ) . A similar trend toward a higher peak concentration of alanine transferase and glutathione-S-transferase was indeed observed in the preconditioning group compared with the control group . Morbidity and mortality rates and lengths of ICU and hospitalization stays were similar in both groups . CONCLUSIONS IP does not improve liver tolerance to ischemia-reperfusion after hepatectomy under vascular exclusion of the liver with preservation of the caval flow . This maneuver does not improve postoperative liver function and does not affect morbidity or mortality rates . The clinical use of IP through 10 minutes of warm ischemia in this technique of hepatectomy is not currently recommended BACKGROUND AND AIMS Liver surgery usually involves ischemia and reperfusion ( I/R ) which results in oxidative stress and cell damage . The administration of antioxidants should diminish or prevent this damage . The purpose of this study was to investigate the effect of the antioxidant vitamin E on I/R injury . METHODS We carried out a placebo-controlled double-blind study on 68 patients undergoing elective , tumor-related , partial liver resection . 47 patients were qualified for the per protocol population based evaluation . The patients were r and omly assigned to two groups . The day before surgery one group received three infusions containing vitamin E ( 600 IU=540 mg vitamin E emulsion ) . The other group received three infusions of placebo . RESULTS Length of stay in the intensive care unit ( ICU ) was significantly shorter in the verum group than in the placebo group ( P<0.05 ) . There were signs of improvement for AUC AST ( P<0.05 ) , ALT and GLDH in the verum group after surgery . Serum vitamin E concentration increased after administration of vitamin E infusion and declined in both treatment groups after surgery ( P<0.01 ) . In the verum group vitamin E deficiency was prevented while vitamin E concentration remained low in the placebo group ( P<0.01 ) . CONCLUSIONS The findings from this study indicate that preoperative administration of vitamin E is safe and that this treatment may have beneficial effects by reducing the impact of I/R injury in liver surgery Hepatic pedicle clamping ( HPC ) is widely used to control intraoperative bleeding during hepatectomy ; intermittent HPC is better tolerated but is associated with blood loss during each period of reperfusion . Recently , it has been shown that ischemic preconditioning ( IP ) reduces the ischemia-reperfusion damage for up to 30 minutes of continuous clamping in healthy liver . We evaluated the safety of IP for more prolonged periods of continuous clamping in 42 consecutive patients with healthy liver su bmi tted to hepatectomy . IP was used in 21 patients ( group A ) ; mean + /- SD of liver ischemia was 54 + /- 19 minutes ( range , 27 - 110 ; in 7 cases > 60 minutes ) . In the other 21 patients , continuous clamping alone was used ( Group B ) ; liver ischemia lasted 36 + /- 14 minutes ( range , 13 - 70 ; in 2 cases > 60 minutes ) . Two patients in Group A ( 9.5 % ) and 3 in Group B ( 14.2 % ) received blood transfusions . In spite of the longer duration of ischemia ( P=.001 ) , patients with IP had lower aspartate aminotransferase ( AST ; P=.03 ) and alanine aminotransferase ( ALT ; P = not significant ) at postoperative day 1 , with a similar trend at postoperative day 3 . This was reconfirmed by multiple regression analysis , which showed that although postoperative transaminases increased with increasing duration of ischemia and of the operation in both groups , the increases were significantly smaller ( P<.001 ) with the use of preconditioning . In conclusion , the present study confirms that IP is safe and effective for liver resection in healthy liver and is also better tolerated than continuous clamping alone for prolonged periods of ischemia . This technique should be preferred to continuous clamping alone in healthy liver . Additional studies are needed to assess the role of IP in cirrhotic liver and to compare IP with intermittent clamping Background The success of hepatectomy can be associated with intraoperative blood loss because massive blood loss causes a poor prognosis . This study was design ed to evaluate the effect of infrahepatic inferior vena cava ( IVC ) clamping on the bleeding amount during hepatectomy . Methods Eighty-five patients scheduled to undergo hepatic resection were r and omly assigned to the IVC clamping or an IVC nonclamping group according to age , indocyanine green retention rate at 15 minutes , operative procedure , and number of tumors by prospect i ve , r and omized method . All analyses were compared by Mann-Whitney U test . Results Forty-three patients were assigned to the IVC clamping group and 42 to the nonclamping group ( IVC clamping group vs. non-clamping ) : total blood loss ( 499 vs. 584 ml ; p = 0.567 ) , amount of bleeding during hepatectomy ( 233 vs. 285 ml ; p = 0.474 ) , amount of bleeding during hepatectomy/area of dissection ( 4.9 vs. 6.6 ml/cm2 ; p = 0.63 ) , CVP difference ( −3 cmH2O vs. −1 cmH2O ; p < 0.01 ) , and diameter of the right hepatic vein ( −2.2 cm vs. 0 ; p < 0.01 ) . Conclusions Although we had speculated that infrahepatic IVC clamping would reduce blood loss during hepatectomy , we failed to demonstrate any beneficial effects in this clinical setting with low CVP OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials Output:

Hepatic vascular occlusion does not decrease the blood transfusion requirements . It decreases the cardiac output and increases the systemic vascular resistance . In the comparison between continuous portal triad clamping and intermittent portal triad clamping , four of the five liver failures occurred in patients with chronic liver diseases undergoing the liver resections using continuous portal triad clamping . There was no difference in any of the other important outcomes in any of the comparisons . In elective liver resection , hepatic vascular occlusion can not be recommended over portal triad clamping . Intermittent portal triad clamping seems to be better than continuous portal triad clamping at least in patients with chronic liver disease . There is no evidence to support selective inflow occlusion over portal triad clamping . The optimal method of intermittent portal triad clamping is not clear . There is no evidence for any difference between the ischaemic preconditioning followed by vascular occlusion and intermittent vascular occlusion for liver resection in patients with non-cirrhotic livers .

MS2_1shot569

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To report experimental impacts of a universal , integrated school-based intervention in social-emotional learning and literacy development on change over 1 school year in 3rd- grade children 's social-emotional , behavioral , and academic outcomes . METHOD This study employed a school-r and omized , experimental design and included 942 3rd- grade children ( 49 % boys ; 45.6 % Hispanic/Latino , 41.1 % Black/African American , 4.7 % non-Hispanic White , and 8.6 % other racial/ethnic groups , including Asian , Pacific Isl and er , Native American ) in 18 New York City public elementary schools . Data on children 's social-cognitive processes ( e.g. , hostile attribution biases ) , behavioral symptomatology ( e.g. , conduct problems ) , and literacy skills and academic achievement ( e.g. , reading achievement ) were collected in the fall and spring of 1 school year . RESULTS There were main effects of the 4Rs Program after 1 year on only 2 of the 13 outcomes examined . These include children 's self-reports of hostile attributional biases ( Cohen 's d = 0.20 ) and depression ( d = 0.24 ) . As expected based on program and developmental theory , there were impacts of the intervention for those children identified by teachers at baseline with the highest levels of aggression ( d = 0.32 - 0.59 ) on 4 other outcomes : children 's self-reports of aggressive fantasies , teacher reports of academic skills , reading achievement scaled scores , and children 's attendance . CONCLUSIONS This report of effects of the 4Rs intervention on individual children across domains of functioning after 1 school year represents an important first step in establishing a better underst and ing of what is achievable by a schoolwide intervention such as the 4Rs in its earliest stages of unfolding . The first-year impacts , combined with our knowledge of sustained and exp and ed effects after a second year , provide evidence that this intervention may be initiating positive developmental cascades both in the general population of students and among those at highest behavioral risk . ( PsycINFO Data base Record ( c ) 2010 APA , all rights reserved ) The Media Ready Program was design ed as a middle school , media literacy education , preventive intervention program to improve adolescents ' media literacy skills and reduce their intention to use alcohol or tobacco products . In a short-term efficacy trial , schools in North Carolina were r and omly assigned to conditions ( Media Ready : n = 214 ; control : n = 198 ) . Boys in the Media Ready group reported significantly less intention to use alcohol in the future than did boys in the control group . Also , students in the Media Ready group who had used tobacco in the past reported significantly less intention to use tobacco in the future than did students in the control group who had previously used tobacco . Multilevel multiple mediation analyses suggest that the set of logical analysis Message Interpretation Processing variables mediated the program 's effect on students ' intentions to use alcohol or tobacco in the future OBJECTIVE To test the efficacy of 2 programs design ed to reduce high-risk behaviors among inner-city African American youth . DESIGN Cluster r and omized trial . SETTING Twelve metropolitan Chicago , Ill , schools and the communities they serve , 1994 through 1998 . PARTICIPANTS Students in grade s 5 through 8 and their parents and teachers . INTERVENTIONS The social development curriculum ( SDC ) consisted of 16 to 21 lessons per year focusing on social competence skills necessary to manage situations in which high-risk behaviors occur . The school/community intervention ( SCI ) consisted of SDC and school-wide climate and parent and community components . The control group received an attention-placebo health enhancement curriculum ( HEC ) of equal intensity to the SDC focusing on nutrition , physical activity , and general health care . MAIN OUTCOME MEASURES Student self-reports of violence , provocative behavior , school delinquency , substance use , and sexual behaviors ( intercourse and condom use ) . RESULTS For boys , the SDC and SCI significantly reduced the rate of increase in violent behavior ( by 35 % and 47 % compared with HEC , respectively ) , provoking behavior ( 41 % and 59 % ) , school delinquency ( 31 % and 66 % ) , drug use ( 32 % and 34 % ) , and recent sexual intercourse ( 44 % and 65 % ) , and improved the rate of increase in condom use ( 95 % and 165 % ) . The SCI was significantly more effective than the SDC for a combined behavioral measure ( 79 % improvement vs 51 % ) . There were no significant effects for girls . CONCLUSIONS Theoretically derived social-emotional programs that are culturally sensitive , developmentally appropriate , and offered in multiple grade s can reduce multiple risk behaviors for inner-city African American boys in grade s 5 through 8 . The lack of effects for girls deserves further research BACKGROUND We examined the differential impact of a well-established human immunodeficiency virus (HIV)/sexually transmitted infections ( STIs ) curriculum , Be Proud ! Be Responsible ! , when taught by school nurses and health education classroom teachers within a high school curricula . METHODS Group-r and omized intervention study of 1357 ninth and tenth grade students in 10 schools . Twenty-seven facilitators ( 6 nurses , 21 teachers ) provided programming ; nurse-led classrooms were r and omly assigned . RESULTS Students taught by teachers were more likely to report their instructor to be prepared , comfortable with the material , and challenged them to think about their health than students taught by a school nurse . Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention , compared to controls . Yet , those taught by school nurses reported significant and sustained changes ( up to 12 months after intervention ) in attitudes , beliefs , and efficacy , whereas those taught by health education teachers reported far fewer changes , with sustained improvement in condom knowledge only . CONCLUSIONS Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students ; however , teaching the technical ( eg , condom use ) and interpersonal ( eg , negotiation ) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have OBJECTIVES We sought to test the efficacy of an intervention that was design ed to promote social inclusion and commitment to education , in reducing among students health risk behaviors and improving emotional well-being . METHODS The design was a cluster-r and omized trial in 25 secondary schools in Victoria , Australia . The subjects were 8th- grade students ( aged 13 to 14 y ) in 1997 ( n=2545 ) and subsequent 8th- grade students in 1999 ( n=2586 ) and 2001 ( n=2463 ) . The main outcomes were recent substance use , antisocial behavior , initiation of sexual intercourse , and depressive symptoms . RESULTS At 4-year follow-up , the prevalence of marked health risk behaviors was approximately 20 % in schools in the comparison group and 15 % in schools in the intervention group , an overall reduction of 25 % . In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models ( odds ratio [OR]= 0.69 ; 95 % confidence interval [CI]= 0.50 , 0.95 ) and adjusted models ( OR= 0.71 ; CI = 0.52 , 0.97 ) for potential confounders . There was no evidence of a reduction in depressive symptoms . CONCLUSION The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments Summary of Etiological Analyses . T his analysis confirm ed the i m portance of school bonding to child devel-opm ent . V arious techniques w ere used to exam ine the rela-tionship betw een school bonding and positive and problembehavior , and these relationships w ere found during child-h o o d and ad o lescen ce . S chool b o n d in g in elem en taryschool w as related to initiation of drinking , sm oking , and alcohol abuse and dependence at age 2 1 . It also related tolow er likelihood of becom ing serious offenders in m iddleschool and joining a gang in adolescence . E lem entary and m iddle school bonding had a negative effect on violence inm iddle school through age 2 1 . It also reduced the chance ofschool m isbehavior , grade repetition , and dropout . S choolbonding also affected positive developm ent . S chool bond-ing w as associated w ith increases in academ ic achievem ent and social skills . S chool bonding effects extended to high -risk groups including aggressive boys , children w ith parent sw ho m odeled problem behaviors , and children from low -incom e fam ilies . S chool bonding in m iddle school w asrelated to desistance of serious delinquent behavior . T herelationship w as m aintained through age 2 1 , w ith studentsreporting greater school bonding in sevent h grade m orelikely to desist rather than escalate the seriousness of theiroffending . S chool bonding in m iddle school and the patternof bonding throughout m iddle and high school also relatedto reduced levels of substance use in 12th grade . T h u s , school bonding during elem entary and m iddle school w asconsistently related negatively to problem behaviors in thislongitudinal study .S everal com peting factors that m ight explain the rela-tionship betw een school bonding and problem behaviorsw ere controlle d in the analyses , lending credibilit y to thepotential causal effect of school bonding . H ow ever , w hilenonexperim ental , longitudinal studies establish tim e order , they do not establish cause . A stronger criterion for estab-lishing the causal effect of school bonding com es fromintervention studies aim ed at changing the levels of schoolbonding and exam ining the effects on positive and problembehavior . S tatistically significant results of the preventionexperim ent em bedded w ithin S S D P are described below This study contributes to ongoing scholarship at the nexus of translational research , education reform , and the developmental and prevention sciences . It reports 2-year experimental impacts of a universal , integrated school-based intervention in social-emotional learning and literacy development on children 's social-emotional , behavioral , and academic functioning . The study employed a school-r and omized , experimental design with 1,184 children in 18 elementary schools . Children in the intervention schools showed improvements across several domains : self-reports of hostile attributional bias , aggressive interpersonal negotiation strategies , and depression , and teacher reports of attention skills , and aggressive and socially competent behavior . In addition , there were effects of the intervention on children 's math and reading achievement for those identified by teachers at baseline at highest behavioral risk . These findings are interpreted in light of developmental cascades theory and lend support to the value of universal , integrated interventions in the elementary school period for promoting children 's social-emotional and academic skills Output:

All this is driven by the salience of international metrics of attainment as used , for example , by the Program for International Student Assessment .10,11 The decline of PSHE is of particular concern because there is strong evidence from systematic review s that school curriculum-based health education is one key element in strategies to reduce outcomes such as alcohol consumption,12 smoking,13 drug

MS2_1shot570

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE The purpose of this study was to determine the cost-effectiveness of knee arthroscopy and anterior cruciate ligament ( ACL ) reconstruction . METHODS Retrospective analysis of prospect ively collected data from a single-surgeon , institutional review board-approved outcomes registry included 2 cohorts : surgically treated knee arthroscopy and ACL reconstruction patients . Our outcome measure is cost-effectiveness ( cost of a quality -adjusted life-year [ QALY ] ) . The QALY is calculated by multiplying difference in health-related quality of life , before and after treatment , by life expectancy . Health-related quality of life is measured by use of the Quality of Well-Being scale , which has been vali date d for cost-effectiveness analysis . Costs are facility charges per the facility cost-to-charges ratio plus surgeon fee . Sensitivity analyses are performed to determine the effect of variations in costs or outcomes . RESULTS There were 93 knee arthroscopy and 35 ACL reconstruction patients included at a mean follow-up of 2.1 years . Cost per QALY was $ 5,783 for arthroscopy and $ 10,326 for ACL reconstruction ( 2009 US dollars ) . Sensitivity analysis shows that our results are robust ( relatively insensitive ) to variations in costs or outcomes . CONCLUSIONS Knee arthroscopy and knee ACL reconstruction are very cost-effective Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers Background and Purpose — There are limited real-world data comparing the effectiveness and safety of non-vitamin K antagonist oral anticoagulants ( NOACs ) and warfarin in Asians with nonvalvular atrial fibrillation . We aim ed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population , with particular focus on high-risk patients . Methods — Using the Korean National Health Insurance Service data base , we analyzed the risk of ischemic stroke , intracranial hemorrhage ( ICH ) events , and all-cause death in NOAC users ( n=11 611 total , n=5681 taking rivaroxaban , n=3741 taking dabigatran , and n=2189 taking apixaban ) compared with propensity score-matched warfarin users ( n=23 222 ) among patients with high-risk atrial fibrillation ( CHA2DS2-VASc score ≥2 ) between 2014 and 2015 . Results — NOAC treatment was associated with similar risk of ischemic stroke and lower risk of ICH and all-cause mortality compared with warfarin . All 3 NOACs were associated with a similar risk of ischemic stroke and a lower risk of ICH compared with warfarin . Dabigatran and apixaban were associated with a lower risk of total mortality and the composite net clinical outcome ( ischemic stroke , ICH , and all-cause death ) compared with warfarin , whereas this was nonsignificant for rivaroxaban . Among previously oral anticoagulant – naive patients ( n=23 262 ) , dabigatran and apixaban were superior to warfarin for ICH prevention , whereas rivaroxaban and warfarin were associated with similar risk of ICH . Conclusions — In real-world practice among a high-risk Asian atrial fibrillation population , all 3 NOACs demonstrated similar risk of ischemic stroke and lower risk of ICH compared with warfarin . All-cause mortality was significantly lower only with dabigatran and apixaban OBJECTIVES Heart transplantation ( HT ) and ventricular assist devices ( VAD ) for the management of end-stage heart failure have not been directly compared . We compare the outcomes and use of re sources with these 2 strategies in 2 European countries with different allocation systems . METHODS We studied 83 patients managed by VAD as the first option in Bad Oeynhausen , Germany ( Group I ) and 141 managed with either HT or medical therapy , as the first option , in Paris , France ( Group II ) . The primary end-point was 2-year survival . Kaplan-Meier analyses were performed after the application of propensity score weights to mitigate the effects of non-r and om group assignment . The secondary end-points were re source utilization and costs . Subgroup analyses were performed for patients undergoing HT and patients treated with inotropes at the enrolment time . RESULTS The Group I patients were more severely ill and haemodynamically compromised , and 28 % subsequently underwent HT vs 55 % primary HT in Group II , P < 0.001 . The adjusted probability of survival was 44 % in Group I vs 70 % in Group II , P < 0.0001 . The mean cumulated 2-year costs were € 281 361 ± 156 223 in Group I and € 47 638 ± 35 061 in Group II , P < 0.0001 . Among patients who underwent HT , the adjusted probability of survival in Group I ( n = 23 ) versus Group II ( n = 78 ) was 76 % versus 68 % , respectively ( 0.09 ) , though it differed in the inotrope-treated subgroups ( 77 % in Group I vs 67 % in Group II , P = 0.04 ) . CONCLUSIONS HT should remain the first option for end-stage heart failure patients , associated with improved outcomes and better cost-effectiveness profile . VAD devices represent an option when transplant is not possible or when patient presentation is not optimal Background Surgical site infections ( SSIs ) lead to increased patient morbidity and healthcare costs . Our objective was to decrease the SSI rate following gynecologic surgery . Methods Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following : patient education ; preoperative antibacterial soap ; appropriate antibiotic prophylaxis ; change of gloves and use of clean instruments at surgical closure ; surgical dressing for 48 h ; and a post-discharge phone call . The baseline SSI rate was determined retrospectively ( 1 April 2014–30 June 2014 ) , while the post-intervention SSI rate was determined prospect ively ( 16 February 2015–15 October 2015 ) . The main outcome was the overall SSI rate with secondary outcomes , including the rate of superficial , deep , incisional and organ space infection , as well as the cost effectiveness of the bundle . Results A total of 232 baseline and 555 post-intervention patients were included in the study . No differences were observed between the baseline and post-intervention groups with regard to median body mass index ( BMI ) , surgical approach , receipt of preoperative chemotherapy and /or radiation therapy , and cases including bowel surgery . Overall , the SSI rate decreased significantly from baseline [ 12.5 % ] to post-intervention [ 7.4 % ] ( odds ratio [ OR ] 0.56 , 90 % confidence interval [ CI ] 0.37–0.85 ; p = 0.01 ) . A 40 % decrease was noted in the rate of superficial and deep infections ( 9.5 vs. 5.9 % ; OR 0.60 , 90 % CI 0.38–0.97 ; p = 0.04 ) and SSIs after open surgery ( 21.4 vs. 13.2 % ; OR 0.56 , 90 % CI 0.34–0.92 ; p = 0.03 ) . The estimated cost of the intervention was $ 19.26/case and the net total amount saved during the post-intervention period was $ 65,625 month . Conclusions This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective . The largest decreases in SSIs were in incisional infections and following open surgery Purpose and hypothesis The main purpose of the study is to put focus on the costs related to treating posterior cruciate ligament ( PCL ) injuries and the possible implication s of chosen treatment strategy to the respective institutions and society . Methods Costs of treating PCL injuries nonoperatively and for both single-bundle ( SB ) and double-bundle ( DB ) reconstruction were estimated . These costs were translated into equivalent quality -adjusted life years ( QALY ) given a threshold value of Euro ( € ) 70,000 per QALY . Expected gain in knee osteoarthritis outcome score ( KOOS ) quality of life ( QoL ) following surgery based on KOOS data from 112 patients was used as a basis for calculating the cost efficiency ratio . Results The average calculated cost of nonoperative treatment was € 3382 . Incremental cost for SB PCLR was € 8585 ( 154 % ) and another increment of € 5220 ( 61 % ) for DB PCLR using numbers from a European hospital . This is equivalent to increments of 0.074 ( SB ) and another 0.075 ( DB ) QALYs given the € 70,000 threshold . For DB to be as cost efficient as SB reconstruction , the incremental gain in KOOS QoL has to be at the same level as for SB reconstruction compared to nonoperative treatment . Conclusion Though surgical reconstruction adds a substantial cost to nonoperative treatment alone , it can be considered cost-effective . Double-bundle reconstruction is less cost efficient than SB reconstruction , but should probably still be considered the treatment of choice for certain patient categories . R and omized controlled trials looking at outcome following nonoperative , SB and DB PCL reconstruction are needed . The clinical relevance of this is that surgical reconstruction of PCL injuries is a cost-efficient treatment alternative in patients with an isolated PCL injury . This finding should be taken into consideration when deciding on how to treat these injuries . Level of evidence III Objective To complete an economic evaluation within a r and omised controlled trial ( RCT ) comparing the use of an electronic discharge communication tool ( eDCT ) compared with usual care . Setting Patients being discharged from a single tertiary care centre ’s internal medicine Medical Teaching Units . Participants Between January 2012 and December 2013 , 1399 patients were r and omised to a discharge mechanism . Forty-five patients were excluded from the economic evaluation as they did not have data for the index hospitalisation cost ; 1354 patients contributed to the economic evaluation . Intervention eDCT generated at discharge containing structured content on reason for admission , details of the hospital stay , treatments received and follow-up care required . The control group was discharged via traditional dictation methods . Primary and secondary outcome measures The primary economic outcome was the cost per quality -adjusted life year ( QALY ) gained . Secondary outcomes included the cost per death avoided and the cost per readmission avoided . Results The average transcription cost was $ C22.28 per patient , whereas the estimated cost of the eDCT was $ C13.33 per patient . The cost per QALY gained was $ C239 933 in the eDCT arm compared with usual care due to the very small gains in effectiveness and approximately $ C800difference in re source utilisation costs . The bootstrap analyses result ed in eDCT being more effective and more costly in 29.2 % of sample s , less costly and more effective in 29.2 % of sample s , less effective and more costly in 23.9 % of sample s and finally , less costly and less effective in 17.7 % of sample s. Conclusions The eDCT reduced per patient costs of the generation of discharge summaries . The bootstrap estimates demonstrate considerable uncertainty supporting the finding of neutrality reported in the clinical component of the R Output:

The most frequently assessed illnesses were neoplasms while the most evaluated interventions were pharmacological . The main source of costs and effects of RWD were information systems .

MS2_1shot571

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective To evaluate the efficacy of certolizumab pegol ( CZP ) in improving endoscopic lesions in patients with active ileocolonic Crohn 's disease ( CD ) . Methods This phase IIIB multicentre open-label clinical trial enrolled 89 adult patients with active endoscopic disease ( ulceration in ≥2 intestinal segments with a Crohn 's Disease Endoscopic Index of Severity ( CDEIS ) score ≥8 points ) . Patients received subcutaneous CZP 400 mg at weeks 0 , 2 and 4 and every 4 weeks up to week 52 . Endoscopic evaluations were performed at weeks 0 , 10 and 54 . The primary outcome was mean change in CDEIS score at week 10 ; secondary outcome measures included endoscopic response ( decrease in CDEIS score > 5 points ) , remission ( CDEIS score < 6 ) , complete remission ( CDEIS score <3 ) and mucosal healing ( no ulcer ) at weeks 10 and 54 . Results In the intention-to-treat population ( n=89 ) the mean±SD CDEIS score was 14.5±5.3 at baseline ; the mean decrease in CDEIS score at week 10 was 5.7 ( 95 % CI 4.6 to 6.8 , p<0.0001 ) . Rates of endoscopic response , endoscopic remission , complete endoscopic remission and mucosal healing at week 10 were 54 % , 37 % , 10 % and 4 % , respectively . At week 54 the corresponding rates were 49 % , 27 % , 14 % and 8 % , respectively . The safety profile was consistent with that of previous CZP trials . Conclusions Following CZP treatment in patients with active CD , endoscopic lesions were improved as shown by the decrease in mean CDEIS score and by endoscopic response and remission rates . These benefits were achieved as early as week 10 and were generally maintained through week 54 . Clinical Trial Registration Number NCT00297648 BACKGROUND & AIMS The aim of this study was to evaluate the usefulness of short-term infliximab combined with azathioprine ( AZA ) or 6-mercaptopurine ( 6-MP ) in steroid-dependent Crohn 's disease patients . METHODS Patients with active disease despite prednisone given for more than 6 months were eligible and were stratified as follows : the failure stratum consisted of patients receiving AZA/6-MP at a stable dose for more than 6 months , and the naive stratum consisted of patients not treated previously with AZA/6-MP . Patients were r and omized to infliximab 5 mg/kg or placebo at weeks 0 , 2 , and 6 . All patients were treated with AZA/6-MP maintained at a stable dose throughout the 52 weeks of the study . The primary end point was remission off steroids at week 24 . RESULTS Among the 113 enrolled patients ( 55 in the failure stratum ) , 57 were assigned to infliximab . At week 24 , the success rate ( intent-to-treat analysis ) was higher in the infliximab group than in the placebo group ( 57 % vs 29 % ; P = .003 ) ; at weeks 12 and 52 , the corresponding rates were 75 % vs 38 % ( P < .001 ) and 40 % vs 22 % ( P = .04 ) , respectively . In each stratum , the success rate was significantly higher in the infliximab group at weeks 12 and 24 , and a trend was found at week 52 . In the failure stratum , only 27 % of the patients in the infliximab group were still in remission off steroids , compared with 52 % in the naive stratum . Steroid resistance was less common and the cumulative dose of prednisone was lower in the infliximab group . CONCLUSIONS Infliximab plus AZA/6-MP is more effective than AZA/6-MP alone in steroid-dependent Crohn 's disease patients Objective The aim of this study was to assess the efficacy and safety of adalimumab ( ADA ) , a recombinant human monoclonal antibody against tumour necrosis factor α ( TNF ) , for the induction of clinical remission in anti-TNF naïve patients with moderately to severely active ulcerative colitis . Methods This 8-week , multicentre , r and omised , double-blind , placebo-controlled study ( NCT00385736 ) , conducted at 94 centres in North America and Europe , enrolled ambulatory adult patients with Mayo score of ≥6 points and endoscopic subscore of ≥2 points despite treatment with corticosteroids and /or immunosuppressants . Under the original study protocol , 186 patients were r and omised ( 1:1 ) to subcutaneous treatment with ADA160/80 ( 160 mg at week 0 , 80 mg at week 2 , 40 mg at weeks 4 and 6 ) or placebo . Subsequently , at the request of European regulatory authorities , the protocol was amended to include a second induction group ( ADA80/40 : 80 mg at week 0 , 40 mg at weeks 2 , 4 and 6 ) . The primary efficacy endpoint was clinical remission ( Mayo score ≤2 with no individual subscore > 1 ) at week 8 , assessed in 390 patients r and omised ( 1:1:1 ) to ADA160/80 , ADA80/40 , or placebo . Safety was assessed in all enrolled patients . Patients , study site personnel , investigators , and the sponsor were blinded to treatment assignment . Results At week 8 , 18.5 % of patients in the ADA160/80 group ( p=0.031 vs placebo ) and 10.0 % in the ADA80/40 group ( p=0.833 vs placebo ) were in remission , compared with 9.2 % in the placebo group . Serious adverse events occurred in 7.6 % , 3.8 % and 4.0 % of patients in the placebo , ADA80/40 , and ADA160/80 groups , respectively . There were two malignancies in the placebo group , none in the ADA groups . There were no cases of tuberculosis and no deaths . Conclusions ADA160/80 was safe and effective for induction of clinical remission in patients with moderately to severely active ulcerative colitis failing treatment with corticosteroids and /or immunosuppressants . Clinical trial NCT00385736 OBJECTIVES : Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn 's disease ( SES-CD ) and noninvasive markers are scarce . The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin , C-reactive protein ( CRP ) , blood leukocytes , and the Crohn 's disease activity index ( CDAI ) . METHODS : Crohn 's disease patients undergoing complete ileocolonoscopy were prospect ively enrolled and scored independently according to the SES-CD and the CDAI . SES-CD was defined as follows : inactive 0–3 ; mild 4–10 ; moderate 11–19 ; and high ≥20 . RESULTS : Values in CD patients ( n=140 ileocolonoscopies ) compared with controls ( n=43 ) are as follows : calprotectin , 334±322 vs. 18±5 μg/g ; CRP , 26±29 vs. 3±2 mg/l ; and blood leukocytes , 9.1±3.4 vs. 5.4±1.9 g/l ( all P<0.001 ) . The SES-CD correlated closest with calprotectin ( Spearman 's rank correlation coefficient r=0.75 ) , followed by CRP ( r=0.53 ) , blood leukocytes ( r=0.42 ) , and the CDAI ( r=0.38 ) . Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity ( 104±138 vs. 231±244 μg/g , P<0.001 ) , mild from moderate activity ( 231±244 vs. 395±256 μg/g , P=0.008 ) , and moderate from high activity ( 395±256 vs. 718±320 μg/g , P<0.001 ) . The overall accuracy for the detection of endoscopically active disease was 87 % for calprotectin ( cutoff 70 μg/g ) , 66 % for elevated CRP , 54 % for blood leukocytosis , and 40 % for the CDAI ≥150 . CONCLUSIONS : Fecal calprotectin correlated closest with SES-CD , followed by CRP , blood leukocytes , and the CDAI . Furthermore , fecal calprotectin was the only marker that reliably discriminated inactive from mild , moderate , and highly active disease , which underlines its usefulness for activity monitoring Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Adalimumab is a fully human , monoclonal antibody against tumor necrosis factor that is approved in Western countries for the treatment of moderately to severely active ulcerative colitis ( UC ) . Methods This 52-week , phase 2/3 , r and omized , double-blind study evaluated adalimumab for induction and maintenance treatment in 273 anti-TNF – naive Japanese patients with UC who were refractory to corticosteroids , immunomodulators , or both . Patients received placebo , adalimumab 80/40 ( 80 mg at week 0 , then 40 mg every other week ) , or adalimumab 160/80 ( 160/80 mg at weeks 0/2 , then 40 mg every other week ) in addition to background UC therapy . Results At week 8 , remission rates were similar among treatment arms , but more patients treated with adalimumab 160/80 achieved response ( placebo , 35 % ; 80/40 , 43 % ; 160/80 , 50 % ; P = 0.044 for 160/80 vs placebo ) and mucosal healing ( placebo , 30 % ; 80/40 , 39 % ; 160/80 , 44 % ; P = 0.045 for 160/80 vs placebo ) compared with placebo . At week 52 , more patients receiving adalimumab 40 mg every other week achieved response ( 18 vs 31 % ; P = 0.021 ) , remission ( 7 vs 23 % ; P = 0.001 ) , and mucosal healing ( 16 vs 29 % ; P = 0.015 ) compared with placebo . Week 8 response to adalimumab was associated with greater rates of response ( 61 % ) , remission ( 46 % ) , and mucosal healing ( 57 % ) at week 52 relative to the overall population . Rates of serious adverse events were similar between treatment arms . Conclusions Induction with adalimumab 160/80 mg led to early response and mucosal healing . Maintenance adalimumab had greater rates of long-term response , remission , and mucosal healing compared with placebo . No new safety signals were identified BACKGROUND The comparative efficacy and safety of infliximab and azathioprine therapy alone or in combination for Crohn 's disease are unknown . METHODS In this r and omized , double-blind trial , we evaluated the efficacy of infliximab monotherapy , azathioprine monotherapy , and the two drugs combined in 508 adults with moderate-to-severe Crohn 's disease who had not undergone previous immunosuppressive or biologic therapy . Patients were r and omly assigned to receive an intravenous infusion of 5 mg of infliximab per kilogram of body weight at weeks 0 , 2 , and 6 and then every 8 weeks plus daily oral placebo capsules ; 2.5 mg of oral azathioprine per kilogram daily plus a placebo infusion on the st and ard schedule ; or combination therapy with the two drugs . Patients received study medication through week 30 and could continue in a blinded study extension through week 50 . RESULTS Of the 169 patients receiving combination therapy , 96 ( 56.8 % ) were in corticosteroid-free clinical remission at week 26 ( the primary end point ) , as compared with 75 of 169 patients ( 44.4 % ) receiving infliximab alone ( P=0.02 ) and 51 of 170 patients ( 30.0 % ) receiving azathioprine alone ( P<0.001 for the comparison with combination therapy and P=0.006 for the comparison with infliximab ) . Similar numerical trends were found at week 50 . At week 26 , mucosal healing had occurred in 47 of 107 patients ( 43.9 % ) receiving combination therapy , as compared with 28 of 93 patients ( 30.1 % ) receiving infliximab ( P=0.06 ) and Output:

There was no statistically significant pairwise difference between vedolizumab and anti-TNF agents in UC . CONCLUSIONS Anti-TNF and anti-integrin biological agents are effective in inducing mucosal healing in UC , with adalimumab being inferior to infliximab or combination therapy . Infliximab and adalimumab were similar in CD

MS2_1shot572

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Introduction Environmental stimulus , especially noise and light , is thought to disrupt sleep in patients in the intensive care unit ( ICU ) . This study aim ed to determine the physiological and psychological effects of ICU noise and light , and of earplugs and eye masks , used in these conditions in healthy subjects . Methods Fourteen subjects underwent polysomnography under four conditions : adaptation , baseline , exposure to recorded ICU noise and light ( NL ) , and NL plus use of earplugs and eye masks ( NLEE ) . Urine was analyzed for melatonin and cortisol levels . Subjects rated their perceived sleep quality , anxiety levels and perception of environmental stimuli . Results Subjects had poorer perceived sleep quality , more light sleep , longer rapid eye movement ( REM ) latency , less REM sleep when exposed to simulated ICU noise and light ( P < 0.05 ) . Nocturnal melatonin ( P = 0.007 ) and cortisol secretion levels ( P = 0.004 ) differed significantly by condition but anxiety levels did not ( P = 0.06 ) . Use of earplugs and eye masks result ed in more REM time , shorter REM latency , less arousal ( P < 0.05 ) and elevated melatonin levels ( P = 0.002 ) . Conclusions Earplugs and eye masks promote sleep and hormone balance in healthy subjects exposed to simulated ICU noise and light , making their promotion in ICU patients reasonable AIM AND OBJECTIVE The study compared the effect of earplug-delivered sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit . BACKGROUND Diverse types of music have been cl aim ed to improve sleeping elsewhere , but relatively little is known in South Korea . Most studies investigating the effect of sleep-inducing music on sleep have involved persons with insomnia , even though many persons with cardiovascular disease in the intensive care unit suffer from sleeping problems . There is a need to investigate the effect of sleep-inducing music on sleep disorders in persons with percutaneous transluminal coronary angiography in the cardiac care unit . DESIGN An experimental research design was used . METHODS Data collection was conducted in the cardiac care unit of K University Hospital in D city , from 3 September-4 October 2010 . Fifty-eight subjects participated and were r and omly assigned to the experimental group ( earplug-delivered sleep-inducing music for 52 min beginning at 10:00 pm , while wearing an eyeshield , n = 29 ) and the control group ( no music , but earplugs and eyeshield worn , n = 29 ) . The quantity and quality of sleep were measured using question naires at 7 am the next morning for each group . RESULTS Participants in the experimental group reported that the sleeping quantity and quality were significantly higher than control group ( t = 3·181 , p = 0·002 , t = 5·269 , p < 0·001 , respectively ) . CONCLUSION Sleep-inducing music significantly improved sleep in patients with percutaneous transluminal coronary angiography at a cardiac care unit . Offering earplugs and playing sleep-inducing music may be a meaningful and easily enacted nursing intervention to improve sleep for intensive care unit patients . RELEVANCE TO CLINICAL PRACTICE Nurses working at cardiac care unit can use music to improve sleeping in clients with percutaneous transluminal coronary angiography BACKGROUND Post-anaesthesia care units ( PACUs ) with 24/7 activity and consequently artificial light and noise may disturb the sleep of patients who require prolonged medical supervision . After one postoperative night , we compared sleep quality in patients with and without noise ( earplug ) and light ( eye mask ) protection . METHODS After ethical board approval , 46 patients without any neurological or respiratory failure undergoing major non-cardiac surgery were prospect ively included . They were r and omized to sleep with or without protective devices during the first postoperative night in the PACU . Sleep quality was simultaneously measured by sleep- quality scales ( Spiegel score and Medical Outcomes Study Sleep ) , nurses ' assessment , and through a wrist actigraph ( Actiwatch ) . Secondary outcomes such as pain control and nocturnal activity were recorded . Comparisons between groups were made by Student 's t-test or non-parametric test for repeated measures as appropriate ( SPSS 10.0 ) . A P-value < 0.05 was considered significant . RESULTS Data from 41 patients were analysed . Protective devices during the first postoperative night prevented a decrease in sleep quality compared with st and ard care , as evaluated by the Spiegel scale : 20 ( 4 ) vs 15 ( 5 ) , P=0.006 . These devices significantly decreased the need for a nap [ 50 % 95 % confidence interval ( CI ) ( 20 - 80 ) vs 95 % 95 % CI ( 85 - 100 ) , P<0.001 ] , but had no effect on sleep length evaluated by Actiwatch . The total consumption of morphine was significantly reduced in the first 24 h [ respectively , 15(12 ) mg and 27(17 ) mg , P=0.02 ] . CONCLUSIONS Earplugs and eye masks applied in the PACU during the first postoperative night significantly preserve sleep quality . Such non-invasive and cheap devices may be generalized in the PACU or in intensive care units Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium . Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in an intervention group of 69 patients sleeping with earplugs during the night and a control group of 67 patients sleeping without earplugs during the night . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 . Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , patients sleeping with earplugs developed confusion later than the patients sleeping without earplugs . After the first night in the ICU , patients sleeping with earplugs reported a better sleep perception . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT Background : Patients in coronary care unit are at risk of sleep deprivation . Sleep deprivation can be associated with increased blood pressure and heart rate , raising the risk of developing cardiovascular problems among patients hospitalized in coronary care unit . Objectives : This study was carried out to examine the effect of eye mask on sleep quality in cardiac patients . Patients and Methods : In this r and omized controlled trial , 60 patients who met the inclusion criteria were selected using a convenient sampling method and r and omly allocated into the experimental and control groups . Patients in the control group received routine care . However , in the experimental group , patients received routine care and eye mask for three subsequent nights . In the both groups , the sleep quality was assessed using the Pittsburgh sleep quality index . Data were analyzed by the chi-square test , independent sample s t-test , Mann-Whitney U , and Wilcoxon signed-rank tests . Results : After the study , the median scores of the subjective sleep quality , the sleep latency , the sleep duration , the habitual sleep efficiency , and the sleep disturbances domains , as well as the median score of overall Pittsburgh sleep quality index in the experimental group were significantly lower than those in the control group ( P < 0.05 ) . However , no significant differences were observed between the two groups in terms of the use of sleep medications and the daytime dysfunction domains ( P > 0.05 ) . Conclusions : Using eye mask can significantly improve the sleep quality in cardiac patients . Therefore , nurses are recommended to use eye mask in combination with current treatments for improving patients ’ sleep quality Introduction Intensive care unit ( ICU ) environmental factors such as noise and light have been cited as important causes of sleep deprivation in critically ill patients . Previous studies indicated that using earplugs and eye masks can improve REM sleep in healthy subjects in simulated ICU environment , and improve sleep quality in ICU patients . This study aim ed to determine the effects of using earplugs and eye masks with relaxing background music on sleep , melatonin and cortisol levels in ICU patients . Methods Fifty patients who underwent a scheduled cardiac surgery and were expected to stay at least 2 nights in Cardiac Surgical ICU ( CSICU ) were included . They were r and omized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in CSICU . Urine was analyzed for nocturnal melatonin and cortisol levels . Subjective sleep quality was evaluated using the Chinese version of Richards-Campbell Sleep Question naire ( a visual analog scale , ranging 0–100 ) . Results Data from 45 patients ( 20 in intervention group , 25 in control group ) were analyzed . Significant differences were found between groups in depth of sleep , falling asleep , awakenings , falling asleep again after awakening and overall sleep quality ( P < 0.05 ) . Perceived sleep quality was better in the intervention group . No group differences were found in urinary melatonin levels and cortisol levels for the night before surgery , and the first and second nights post-surgery ( P > 0.05 ) . The urinary melatonin levels of the first and second postoperative nights were significantly lower than those of the night before surgery ( P = 0.01 ) . The opposite pattern was seen with urinary cortisol levels ( P = 0.00 ) . Conclusion This combination of non-pharmacological interventions is useful for promoting sleep in ICU adult patients ; however , any influence on nocturnal melatonin levels and cortisol level may have been masked by several factors such as the timing of surgery , medication use and individual differences . Larger scale studies would be needed to examine the potential influences of these factors on biological markers and intervention efficacy on sleep . Trial registration Chinese Clinical Trial Registry : ChiCTR-IOR-14005511 . Registered 21 November 2014 Introduction Sleep deprivation is common in critically ill patients in the intensive care unit ( ICU ) . Noise and light in the ICU and the reduction in plasma melatonin play the essential roles . The aim of this study was to determine the effect of simulated ICU noise and light on nocturnal sleep quality , and compare the effectiveness of melatonin and earplugs and eye masks on sleep quality in these conditions in healthy subjects . Methods This study was conducted in two parts . In part one , 40 healthy subjects slept under baseline night and simulated ICU noise and light ( NL ) by a cross-over design . In part two , 40 subjects were r and omly assigned to four groups : NL , NL plus placebo ( NLP ) , NL plus use of earplugs and eye masks ( NLEE ) and NL plus melatonin ( NLM ) . 1 mg of oral melatonin or placebo was administered at 21:00 on four consecutive days in NLM and NLP . Earplugs and eye masks were made available in NLEE . The objective sleep quality was measured by polysomnography . Serum was analyzed for melatonin levels . Subjects rated their perceived sleep quality and anxiety levels . Results Subjects had shorter total sleep time ( TST ) and rapid eye movement ( REM ) sleep , longer sleep onset latency , more light sleep and awakening , poorer subjective sleep quality , higher anxiety level and lower serum melatonin level in NL night ( P < 0.05 ) . NLEE had less awakenings and shorter sleep onset latency ( P < 0.05 ) . NLM had longer TST and REM and shorter sleep onset latency ( P < 0.05 ) . Compared with NLEE , NLM had fewer awakenings ( P = 0.004 ) . Both NLM and NLEE improved perceived sleep quality and anxiety level ( P = 0.000 ) , and NLM showed better than NLEE in perceived sleep quality ( P = 0.01 ) . Compared to baseline night , the serum melatonin levels were lower in NL night at every time point , and the average maximal serum melatonin concentration in NLM group was significantly greater than other groups ( P < 0.001 ) . Conclusions Compared with earplugs and eye masks , melatonin improves sleep quality and serum melatonin levels better in healthy subjects exposed to simulated ICU noise and light . Trial registration Chinese Clinical Trial Registry ChiCTR-IPR-14005458 . Registered 10 November 2014 STUDY OBJECTIVES To objective ly measure sleep in critically ill patients requiring mechanical ventilation and to define selection criteria for future studies of sleep continuity in this population . DESIGN Prospect i ve cohort analysis . SETTING University teaching hospital medical-surgical ICU . PATIENTS Twenty critically ill ( APACHE II [ acute physiology and chronic health evaluation II ] acute physiology score [ APS ] , 10 + /- 5 ) , mechanically ventilated adults ( male 12 , female 8 , age 62 + /- 15 years ) with mild to Output:

Most of the review ed studies showed a significant improvement of subjective sleep quality when using described non-pharmacological interventions ( objective parameters were not significantly vali date d ) . Despite the heterogeneity of analysed studies and some common method ological issues ( sample size , design , outcome parameters choice and comparison ) earplugs and eye mask showed potential positive effects on sleep quality and the incidence of delirium in ICU patients

MS2_1shot573

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : To determine the effectiveness of steroids , acyclovir , and surgical facial nerve decompression in Bell ’s palsy . Methods : The authors identified articles by search ing MEDLINE and selected those that prospect ively compared outcomes in patients treated with steroids , acyclovir , or surgery with patients not receiving these modalities . The authors grade d the quality of each study ( class I to IV ) using a st and ard classification-of- evidence scheme . They compared the proportion of patients recovering facial function in the treated group to the proportion of patients recovering facial function in the control group . Results : The authors identified no adequately powered class I studies for any treatment modality . The pooled results of two class I and two class II studies showed significantly better facial outcomes in steroid-treated patients compared with non – steroid-treated patients ( relative rate good outcome 1.16 , 95 % CI 1.05 to 1.29 ) . One class II study demonstrated a significant benefit from acyclovir in combination with prednisone compared with prednisone alone ( relative rate good outcome 1.22 , 95 % CI 1.02 to 1.45 ) . All studies describing outcomes in patients treated with facial nerve decompression were grade d as class IV . Conclusion : For patients with Bell ’s palsy , a benefit from steroids , acyclovir , or facial nerve decompression has not been definitively established . However , available evidence suggests that steroids are probably effective and acyclovir ( combined with prednisone ) is possibly effective in improving facial functional outcomes . There is insufficient evidence to make recommendations regarding surgical facial nerve decompression for Bell ’s palsy . Well- design ed studies of the effectiveness of treatments for Bell ’s palsy are still needed A prospect i ve , controlled , double-blind study was design ed to evaluate the effect of steroid treatment on the natural history of Bell 's palsy . Fifty-one patients were included in the study between 1972 and 1974 . The patients were evaluated and started on treatment within two days of onset of Bell 's palsy and followed for six months . Treatment was given in r and omized double-blind fashion and consisted of either vitamins or a total of 410 mg of prednisone plus vitamins in descending doses over 10 days . The recovery of facial motor function was determined by three physicians who had no knowledge of the treatment received by the patients . They examined photographs of the patients taken six months after onset of paralysis in eight positions of facial function and categorized them as to complete fair , or poor recovery of facial function . These results of this evaluation were su bmi tted to the biostatistician who broke the treatment code . The results of this study demonstrate no statistically significant beneficial effect of steroid therapy upon recovery from Bell 's palsy . Factors considered included the patients ' age , sex , the presence of pain , ageusia , hyperacusis , diabetes , hypertension , the progression and degree of palsy , the results of nerve excitability and salivary flow tests , and the time at which recovery was first noted or became complete . Bell 's palsy remains without a proven efficacious treatment The Quality St and ards Subcommittee of the American Academy of Neurology is charged with developing practice parameters for neurologists for diagnostic procedures , treatment modalities , and clinical disorders . The selection of topics for which practice parameters are used is based on prevalence , frequency of use , economic impact , membership involvement , controversy , urgency , external constraints , and re sources required . This paper addresses the role of thymectomy in the treatment of nonthymomatous autoimmune MG . In 1939 , Blalock et al.1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor . Subsequently , Blalock et al.2,3 performed thymectomy on MG patients without thymoma , found hyperplasia in the thymus gl and s , and reported improvement in at least half of their patients . Since these reports , thymectomy , with or without the presence of thymoma , has gained widespread acceptance as a form of treatment for MG . Because a definitive study of the effectiveness of thymectomy has never been done,4,5 the role of thymectomy in the management of MG remains uncertain . Nevertheless , physicians have to advise their patients regarding the benefits of thymectomy based on the existing literature . Our goal is to develop evidence -based recommendations for clinicians considering thymectomy for patients with nonthymomatous autoimmune MG by performing a systematic review and analysis of the literature . # # # Identification and selection of studies . We search ed the National Library of Medicine ’s Medline data base from 1966 to February 1998 using the medical subject headings “ myasthenia gravis ” ( restricted to the surgery subheading ) and “ thymectomy . ” To identify articles published before 1966 , or missed by our original search strategy , we review ed the references of the identified articles . We classified the result ing articles into the following categories : Class II , controlled but nonr and omized studies describing outcomes in MG patients with and without thymectomy ; and Class III , uncontrolled case series describing outcomes in patients with or without Incomplete recovery from Bell 's palsy was observed in some patients even after the intake of corticosteroids . This prospect i ve study was performed on 160 patients with unilaterial nonrecurrent Bell 's palsy in order to investigate the role of prednisolone on the prognosis of Bell 's palsy . Ninety-three patients were given prednisolone tablets ( 1 mg/kg body wt/day up to 70 mg ) for six successive days , then the dose was reduced gradually over the next four days . The remaining 67 patients were not given prednisolone ( control group ) . Facial nerve recovery was assessed clinical ly and electrophysiologically for up to one year . The results of this study suggested that the most probable contributing factor for the success of prednisolone in improving the prognosis of Bell 's palsy was its early intake ( within the first 24 hours following onset ) Output:

Results are mixed on whether educating physicians about evidence -based recommendations is sufficient to change physician behavior .

MS2_1shot574

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES To evaluate the outcome and satisfaction of closed treatment versus open reduction and internal fixation in comminuted clavicular fractures . METHODS Sixty patients with displaced clavicular fractures were r and omized into operative ( 29 patients ) and nonoperative ( 31 patients ) groups . Three patients in the operative group did not accept the surgery , and seven patients in the nonoperative group did not complete the one-year follow-up . Outcomes were assessed using the Disability of the Arm , Shoulder and H and ( DASH ) score , Constant shoulder score , specific questions regarding patients ' final satisfaction , physical examination , measurement of the shortening of the clavicular length , and plain radiographs . RESULTS There was one nonunion in the operative group and one in the nonoperative group . The nonunion in operative group was the result of the only infection in this group . Four malunions were developed in the operative group and nineteen malunions in the nonoperative treatment , ( p<0.001 ) . Three patients in the operative group were completely dissatisfied with their treatment . Eighteen patients in the nonoperative group were partially satisfied . Pain was the main reason for dissatisfaction in this group . The mean shortening of the clavicle was 26.5 mm in the nonoperative group and 4.0 mm in the operative group . The mean DASH score for the operative and nonoperative groups were 8.6 and 21.3 , respectively ( p<0.001 ) ; and the Constant shoulder scores were 89.8 and 78.8 ( p<0.001 ) . CONCLUSION Open reduction and internal fixation of comminuted fractures of the clavicle using a reconstruction plate is an effective treatment modality . Despite the variety of complications , this method has a higher satisfaction rate than conservative treatment We conducted a prospect i ve , r and omized study to determine if patients with midshaft clavicle fractures would benefit from immediate operative stabilization with a modified Hagie pin in comparison with a matched group treated with nonoperative therapy . At a level II trauma center , patients with closed midshaft clavicle fractures were prospect ively r and omized to receive either operative or nonoperative treatment . Fifty-seven ( 29 operative , 28 nonoperative ) patients were enrolled in the study . Operative patients underwent open reduction and internal fixation of the clavicle using a modified Hagie pin ; nonoperative patients were treated with a sling for comfort . All patients were followed at regular intervals for 1 year . They were evaluated for radiographic healing and complications and were scored with the Single Assessment Numeric Evaluation and L'Insalata instruments . Injury severities and radiographs were not statistically significantly different between the 2 groups . Functional scores in the operative group were slightly higher at 3 weeks , and the nonoperative group had slightly higher scores at 6 months and 1 year . The only statistically significant difference between the groups was at 3 weeks . Percentage follow-up at 1 year was 93 % for the operative group and 82 % for the nonoperative group . One patient in each group developed a nonunion , and 1 patient in each group had a refracture . Complications were higher in the operative group , and most were related to pin prominence at the posterior shoulder . Results of this study suggest that , though patients with midshaft clavicle fractures had higher functional scores at short-term follow-up after internal fixation , functional scores were similar at 6 months and 1 year . In addition , internal fixation with a modified Hagie pin was associated with a higher complication rate Objectives : To determine the cost-effectiveness of open reduction internal fixation ( ORIF ) of displaced , midshaft clavicle fractures in adults . Design : Formal cost-effectiveness analysis based on a prospect i ve , r and omized , controlled trial . Setting : Eight hospitals in Canada ( seven university-affiliated and one community hospital ) . Patients / Participants : One hundred thirty-two adults with acute , completely displaced , midshaft clavicle fractures . Intervention : Clavicle ORIF versus nonoperative treatment . Main Outcome Measurements : Utilities derived from SF-6D . Results : The base case cost per quality -adjusted life-year ( QALY ) gained for ORIF was $ 65,000 . Cost-effectiveness improved to $ 28,150/QALY gained when the functional benefit from ORIF was assumed to be permanent with cost per QALY gained falling below $ 50,000 when the functional advantage persisted for 9.3 years or more . In other sensitivity analyses , the cost per QALY gained for ORIF fell below $ 50,000 when ORIF cost less than $ 10,465 ( base case cost $ 13,668 ) or the long-term utility difference between nonoperative treatment and ORIF was greater than 0.034 ( base case difference 0.014 ) . Short-term disutility associated with fracture healing also affected cost-effectiveness with the cost per QALY gained for ORIF falling below $ 50,000 when the utility of a fracture treated nonoperatively before union was less than 0.617 ( base case utility 0.706 ) or when nonoperative treatment increased the time to union by 20 weeks ( base case difference 12 weeks ) . Conclusions : The cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared with nonoperative treatment . When functional benefits persisted for more than 9 years , ORIF had a favorable value compared with many accepted health interventions Background The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures . Recent studies have presented a relatively high incidence of non-union and identified speciic limitations of the shoulder function in subgroups of patients with these injuries . Aim A prospect i ve , multicentre r and omised controlled trial ( RCT ) will be conducted in 21 hospitals in the Netherl and s , comparing fracture consolidation and shoulder function after either non-operative treatment with a sling or a plate fixation . Methods / design A total of 350 patients will be included , between 18 and 60 years of age , with a dislocated midshaft clavicular fracture . The primary outcome is the incidence of non-union , which will be determined with st and ardised X-rays ( Antero-Posterior and 30 degrees caudocephalad view ) . Secondary outcome will be the functional outcome , measured using the Constant Score . Strength of the shoulder muscles will be measured with a h and held dynamometer ( MicroFET2 ) . Furthermore , the health-related Quality of Life score ( ShortForm-36 ) and the Disabilities of Arm , Shoulder and H and ( DASH ) Outcome Measure will be monitored as subjective parameters . Data on complications , bone union , cosmetic aspects and use of painkillers will be collected with follow-up question naires . The follow-up time will be two years . All patients will be monitored at regular intervals over the subsequent twelve months ( two and six weeks , three months and one year ) . After two years an interview by telephone and a written survey will be performed to evaluate the two-year functional and mechanical outcomes . All data will be analysed on an intention-to-treat basis , using univariate and multivariate analyses . Discussion This trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two st and ardised treatment options for dislocated midshaft clavicular fractures . The gathered data may support the development of a clinical guideline for treatment of clavicular fractures . Trial registration Netherl and s National Trial Register INTRODUCTION Elastic stable intramedullary nailing ( ESIN ) of displaced mid-shaft clavicular fractures is a minimally invasive technique which was reported to be an easy procedure with low complication rates , good cosmetic and functional results , restoration of clavicular length and fast return to daily activities . Recent studies , however , also report on higher complication rates and specific problems with the use of this technique . This prospect i ve study compares ESIN with non-operative treatment of displaced mid-shaft clavicular fractures . METHODS Between December 2003 and August 2007 , 120 patients volunteered to participate . Of these , 112 patients completed the study ( 60 in the operative and 52 in the non-operative group ) . Patients in the non-operative group were treated with a simple shoulder sling . In the operative group , intramedullary stabilisation was performed within 3 days of the trauma . Clavicular shortening was determined after trauma and after osseous consolidation on thorax posteroanterior radiographs as the proportional length difference between the left and right side with the uninjured side serving as a control for clavicular length ( 100 % ) . Radiographic union was assessed every 4 weeks on 20 degrees cephalad anteroposterior and posteroanterior radiographs of the clavicle . Constant shoulder scores and DASH scores ( DASH , disabilities of the arm , shoulder and h and ) were assessed at final follow-up after 2 years . RESULTS ESIN led to faster osseous healing and better restoration of clavicular length in simple fractures . We were not able to restore clavicular length in comminuted fractures using ESIN . Functional outcome at a mean follow-up of 24 months ( range : 22 - 27 months ) was better in the operative group . Delayed union and non-union accounted for the majority of complications in the non-operative group . In the operative group , telescoping was the main complication , which occurred in complex fractures with severe post-traumatic shortening only . CONCLUSION We recommend ESIN for all simple displaced mid-shaft clavicular fractures in order to minimise the rate of delayed union , non-union and symptomatic mal-union . We also recommend ESIN in comminuted fractures with moderate ( < or = 7 % ) post-traumatic shortening , as they will heal with moderate shortening . In comminuted fractures with severe shortening , however , we recommend plate osteo synthesis in order to provide for stability , clavicular length and endosteal blood supply BACKGROUND Clavicle fractures are common and usually heal without complications . In this study , we evaluated the outcomes of non-operative versus operative management of displaced fractures . METHODS In a prospect i ve clinical trial study , sixty-five patients with displaced clavicle mid-shaft fractures were non-r and omly divided in two treatment groups . The first group underwent non-operative treatment with figure of 8 b and age ( 30 patients ) , and the other underwent operative treatment with plate fixation ( 35 patients ) . Figure of 8 b and age and 3.5 millimeter DCP plate with at least six cortical screws were used in non-operative and operative groups respectively . We followed up all patients at weeks 2 , 6 and 12 , and at month sixth . In addition to clinical examination and x-ray evaluation , we assessed satisfaction , DASH and Constant Shoulder Score for each individual . RESULTS The average duration s of union were 19.3 and 24.4 weeks in operative and non-operative groups respectively ( P=0.006 ) . Satisfaction with operative treatment was 74.3 % and with non-operative treatment was 66.7 % , showing no significant difference ( P=0.500 ) . The non-union rate was 5.7 % in the operative group and 13.3 % in the non-operative group ( P=0.518 ) . A significant difference between the two groups in terms of DASH and Constant Shoulder Scores after the six-month follow-up was not found ( P=0.352 ) . CONCLUSIONS According to our results , we recommend operative treatment in mid-shaft clavicle fractures only when there is a definitive indication Objectives : To compare results of primary internal fixation of acute displaced midshaft clavicle fractures with those managed nonoperatively in terms of fracture union and functional outcome . Design : Prospect i ve cohort study . Setting : Level II military trauma center . Patients / Participants : Seventy-three patients ( civilian and military ) between 20 and 50 years of age with displaced midshaft clavicle fractures were allocated either to the operative ( n = 45 ) or nonoperative ( n = 28 ) group . Intervention : Patients in the nonoperative group were managed by simple sling immobilization , whereas in the operative group , fractures were reduced and fixed with a contoured reconstruction plate . Main Outcome Measurements : The patients were actively followed up during an 18-month period . Primary outcome measures were the rates of nonunion and symptomatic malunion ; secondary outcomes included the assessment of the Constant score and the overall local complication rate . Results : The 18-month follow-up rate was 90 % . All fractures in the operative group united compared with eight nonunions ( 29 % ) in the nonoperative group ( P = 0.002 ) . Ten symptomatic malunions ( 36 % ) occurred in the nonoperative group , whereas only two ( 4 % ) were reported for the operative group ( P = 0.0008 ) . Constant shoulder scores were significantly better for the operative group at all follow-ups ( P < 0.0001 ) . All six operative complications were implant-related . Conclusions : In this prospect i ve cohort study , primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures result ed in improved outcomes and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment BACKGROUND Surgical treatment with open reduction and internal fixation ( ORIF ) of displaced middle-third clavicular fractures result ed in shorter complete return to work periods with earlier consolidation documented on computed tomography ( CT ) scans in this prospect i ve , r and omized controlled trial . METHODS The study r and omized 76 consecutive patients with displaced fractures ( 2 Output:

Conclusion : This meta- analysis of high- quality studies showed that surgical treatment of MCFs results in fewer nonunions , fewer malunions , and an accelerated return to work compared with nonsurgical treatment .

MS2_1shot575

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background The phosphoinositide 3-kinase (PI3K)/Akt pathway is constitutively activated in pancreatic cancer and the mammalian target of rapamycin ( mTOR ) kinase is an important mediator for its signaling . Our recent in vitro studies suggest that prolonged exposure of pancreatic cancer cells to mTOR inhibitors can promote insulin receptor substrate-PI3 K interactions and paradoxically increase Akt phosphorylation and cyclin D1 expression in pancreatic cancer cells ( negative feedback loop ) . The addition of erlotinib to rapamycin can down-regulate rapamycin-stimulated Akt and results in synergistic antitumor activity with erlotinib in pre clinical tumor models . Methods Two studies prospect ively enrolled adult patients with advanced pancreatic cancer , Eastern Cooperative Oncology Group performance status 0 - 1 , adequate hematologic , hepatic and renal parameters and measurable disease . In Study A , temsirolimus was administered intravenously at 25 mg weekly . In Study B , everolimus was administered orally at 30 mg weekly and erlotinib was administered at 150 mg daily . The primary endpoint in both studies was overall survival at 6 months . Secondary endpoints included time to progression , progression-free survival , overall survival , response rate , safety and toxicity . Pretreatment tumor biopsies were analyzed by immunofluorescence and laser scanning cytometry for the expression of pmTOR/mTOR , pAkt/Akt , pErk/Erk , pS6 , p4EBP-1 and PTEN . Results Five patients enrolled in Study A ; Two patients died within a month ( rapid disease progression and hemorrhagic stroke , respectively ) . One patient developed dehydration and another developed asthenia . Sixteen patients enrolled in Study B. : 12 males , all ECOG PS = 1 . Median cycles = 1 ( range 1 - 2 ) . Grade 4 toxicity : hyponatremia ( n = 1 ) , Grade 3 : diarrhea ( n = 1 ) , cholangitis ( n = 3 ) , hyperglycemia ( n = 1 ) , fatigue ( n = 1 ) . Grade 2 : pneumonia ( n = 2 ) , dehydration ( n = 2 ) , nausea ( n = 2 ) , neutropenia ( n = 1 ) , mucositis ( n = 2 ) & rash ( n = 2 ) . Four patients were hospitalized . Progressive disease occurred in 15 and 1 was non-evaluable . Pretreatment biopsies revealed a higher pAkt/Akt ratio in tumor specimens that in nonmalignant pancreatic tissue . No such trends were noted for the other biomarkers . Conclusions Neither study with mTOR inhibitors demonstrated objective responses or disease stability . The negative feedback loop result ing from mTOR inhibition may account for the disease progression and toxicity noted in these studies . Future strategies should aim for a broader targeting of the PI3 K pathway in pancreatic cancer . Trial Registration Trial registration : Study A : NCT 0075647 . Study B : Purpose : Loss of PTEN , which is common in glioblastoma multiforme ( GBM ) , results in activation of the mammalian target of rapapmycin ( mTOR ) , thereby increasing mRNA translation of a number of key proteins required for cell-cycle progression . CCI-779 is an inhibitor of mTOR . The primary objectives of this study were to determine the efficacy of CCI-779 in patients with recurrent GBM and to further assess the toxicity of the drug . Experimental Design : CCI-779 was administered weekly at a dose of 250 mg intravenously for patients on enzyme-inducing anti-epileptic drugs ( EIAEDs ) . Patients not on EIAEDs were initially treated at 250 mg ; however , the dose was reduced to 170 mg because of intolerable side effects . Treatment was continued until unacceptable toxicity , tumor progression , or patient withdrawal . The primary endpoint was 6-month progression-free survival . Results : Forty-three patients were enrolled ; 29 were not on EIAEDs . The expected toxicity profile of increased lipids , lymphopenia , and stomatitis was seen . There were no grade IV hematological toxicities and no toxic deaths . One patient was progression free at 6 months . Of the patients assessable for response , there were 2 partial responses and 20 with stabilization of disease . The median time to progression was 9 weeks . Conclusions : CCI-779 was well tolerated at this dose schedule ; however , there was no evidence of efficacy in patients with recurrent GBM . Despite initial disease stabilization in approximately 50 % of patients , the durability of response was short . Because of the low toxicity profile , CCI-779 may merit exploration in combination with other modalities St and ard cytotoxic treatments for neuroendocrine tumours have been associated with limited activity and remarkable toxicity . A phase II study was design ed to evaluate the efficacy , safety and pharmacodynamics of temsirolimus in patients with advanced neuroendocrine carcinoma ( NEC ) . Thirty-seven patients with advanced progressive NEC received intravenous weekly doses of 25 mg of temsirolimus . Patients were evaluated for tumour response , time to progression ( TTP ) , overall survival ( OS ) and adverse events ( AE ) . Twenty-two archival specimens , as well as 13 paired tumour biopsies obtained pretreatment and after 2 weeks of temsirolimus were assessed for potential predictive and correlative markers . The intent-to-treat response rate was 5.6 % ( 95 % CI 0.6–18.7 % ) , median TTP 6 months and 1-year OS rate 71.5 % . The most frequent drug-related AE of all grade s as percentage of patients were : fatigue ( 78 % ) , hyperglycaemia ( 69 % ) and rash/desquamation ( 64 % ) . Temsirolimus effectively inhibited the phosphorylation of S6 ( P=0.02 ) . Higher baseline levels of pmTOR ( phosphorylated mammalian target of rapamycin ) ( P=0.01 ) predicted for a better response . Increases in pAKT ( P=0.041 ) and decreases in pmTOR ( P=0.048 ) after treatment were associated with an increased TTP . Temsirolimus appears to have little activity and does not warrant further single-agent evaluation in advanced NEC . Pharmacodynamic analysis revealed effective mTOR pathway downregulation Hypothesis : To study the progression-free survival ( PFS ) and toxicity with 25- or 250-mg doses of temsirolimus ( CCI-779 ) after induction chemotherapy in patients with extensive small-cell lung cancer . Methods : Patients with either stable or responding disease to four to six cycles of cisplatin or carboplatin plus etoposide or irinotecan were r and omized between 4 and 8 weeks after completion of induction therapy to receive either 25 or 250 mg of temsirolimus intravenously every week until disease progression . Results : Eighty-seven patients entered between January 2002 and December 2003 , of whom 85 were eligible : 44 received 25 mg ( arm A ) , and 41 received 250 mg ( arm B ) . The overall median follow-up time for all eligible patients was 34.6 months . Median age was 59 years ( range , 39–80 ) ; 42 ( 49.4 % ) were male and 43 ( 50.6 % ) female ; 12.9 % had brain metastases . The overall median and 1-year PFS were 2.2 months ( 95 % confidence interval [ CI ] : 1.8 , 2.9 ) and 4.7 % ( 95 % CI : 0.2 % , 9.2 % ) , respectively . The median PFS ( 95 % CI ) for arm A was 1.9 months ( 1.6 , 2.3 ) ; for arm B , it was 2.5 months ( 1.9 , 3.4 ; p = 0.24 ) . The median overall survival from r and omization was 8 months ( 95 % CI : 6.5 , 9.5 ) . Among the 86 patients with reported toxicities , 36 ( 42 % ) had grade 3 toxicities , the most common of which were thrombocytopenia , hypophosphatemia , and fatigue , and an additional 12 ( 14 % ) had grade 4 toxicities , the most common of which was neutropenia . No patients experienced lethal toxicities . Conclusion : Temsirolimus ( CCI 779 ) , given at 25 or 250 mg weekly , seemed not to increase the PFS in this patient population BACKGROUND Temsirolimus ( CCI-779 ) is a small-molecule inhibitor of the mammalian target of rapamycin ( mTOR ) and represents a rational therapeutic target against glioblastoma multiforme ( GBM ) . METHODS Recurrent GBM patients with < or = 1 chemotherapy regimen for progressive disease were eligible . Temsirolimus was administered in a 250-mg intravenous dose weekly . RESULTS Sixty-five patients were treated . The incidence of grade 3 or higher nonhematologic toxicity was 51 % , and consisted mostly of hypercholesterolemia ( 11 % ) , hypertriglyceridemia ( 8 % ) , and hyperglycemia ( 8 % ) . Grade 3 hematologic toxicity was observed in 11 % of patients . Temsirolimus peak concentration ( Cmax ) , and sirolimus Cmax and area under the concentration-time curve were decreased in patients receiving p450 enzyme-inducing anticonvulsants ( EIACs ) by 73 % , 47 % , and 50 % , respectively , but were still within the therapeutic range of pre clinical models . Twenty patients ( 36 % ) had evidence of improvement in neuroimaging , consisting of decrease in T2 signal abnormality + /- decrease in T1 gadolinium enhancement , on stable or reduced steroid doses . Progression-free survival at 6 months was 7.8 % and median overall survival was 4.4 months . Median time to progression ( TTP ) for all patients was 2.3 months and was significantly longer for responders ( 5.4 months ) versus nonresponders ( 1.9 months ) . Development of grade 2 or higher hyperlipidemia in the first two treatment cycles was associated with a higher percentage of radiographic response ( 71 % v 31 % ; P = .04 ) . Significant correlation was observed between radiographic improvement and high levels of phosphorylated p70s6 kinase in baseline tumor sample s ( P = .04 ) . CONCLUSION Temsirolimus is well tolerated in recurrent GBM patients . Despite the effect of EIACs on temsirolimus metabolism , therapeutic levels were achieved . Radiographic improvement was observed in 36 % of temsirolimus-treated patients , and was associated with significantly longer TTP . High levels of phosphorylated p70s6 kinase in baseline tumor sample s appear to predict a patient population more likely to derive benefit from treatment . These findings should be vali date d in other studies of mTOR inhibitors PURPOSE Cross-talk between the estrogen receptor ( ER ) and the phosphoinositide-3-kinase (PI3K)/Akt/mammalian target of rapamycin ( mTOR ) pathways is a mechanism of resistance to endocrine therapy , and blockade of both pathways enhances antitumor activity in pre clinical models . This study explored whether sensitivity to letrozole was enhanced with the oral mTOR inhibitor , everolimus ( RAD001 ) . PATIENTS AND METHODS Two hundred seventy postmenopausal women with operable ER-positive breast cancer were r and omly assigned to receive 4 months of neoadjuvant treatment with letrozole ( 2.5 mg/day ) and either everolimus ( 10 mg/day ) or placebo . The primary end point was clinical response by palpation . M and atory biopsies were obtained at baseline and after 2 weeks of treatment ( ie , day 15 ) . Sample s were assessed for PI3 K mutation status ( PIK3CA ) and for pharmacodynamic changes of Ki67 , phospho-S6 , cyclin D1 , and progesterone receptor ( PgR ) by immunohistochemistry . RESULTS Response rate by clinical palpation in the everolimus arm was higher than that with letrozole alone ( ie , placebo ; 68.1 % v 59.1 % ) , which was statistically significant at the preplanned , one-sided , alpha = 0.1 level ( P = .062 ) . Marked reductions in progesterone receptor and cyclin D1 expression occurred in both treatment arms , and dramatic downregulation of phospho-S6 occurred only in the everolimus arm . An antiproliferative response , as defined by a reduction in Ki67 expression to natural logarithm of percentage positive Ki67 of less than 1 at day 15 , occurred in 52 ( 57 % ) of 91 patients in the everolimus arm and in 25 ( 30 % ) of 82 patients in the placebo arm ( P < .01 ) . The safety profile was Output:

These findings suggest a statistically significant increase in the risk of hyperglycemia , hypercholesterolemia ( all grade s and grade 3 and 4 ) , and all grade hypertriglyceridemia associated with mTOR therapy when compared with control . INTERPRETATION The risk of all grade and grade 3 - 4 , hyperglycemia , hypercholesterolemia , and hypertriglyceridemia , are increase in patients treated with mTOR inhibitors compared with control

MS2_1shot576

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Abstract Background : Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer . Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction . The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced , without increasing shoulder dysfunction , by delayed postoperative shoulder exercises . Methods : In a prospect i ve study 163 patients with breast cancer undergoing modified radical mastectomy were r and omized to physiotherapy starting on postoperative day 1 or day 7 . Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department . Seromas and other complications were registered by the surgeons . The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function . Results : There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 ( 38 % ) compared to the group that started physiotherapy postoperative day 7 ( 22 % ) ( p<0.05 ) . There was no significant difference between the groups in the late outcome of shoulder function . Conclusion : The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively . Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function The role and timing of physical therapy following axillary dissection for melanoma , or in conjunction with modified radical mastectomy has not been extensively studied . A prospect i ve r and omized clinical trial was carried out over an 18-month period in the Surgery Branch , National Cancer Institute ( NCI ) and Department of Rehabilitation Medicine , Clinical Center , in which patients were assigned to receive one of two post-operative physical therapy regimens . Patients were assigned to receive graduated increases in allowed range of motion ( ROM ) , either beginning on postoperative day 1 ( early ) or day 7 ( delayed ) . All patients were advanced to full pain-free ROM when the suction catheters were removed . A total of 36 patients with 40 axillary dissections ( 19 for melanoma , 21 for breast cancer ) were included in this study . Patients r and omized to receive early motion had more total wound drainage ( 805 ± 516 cc vs. 420 ± 301 cc , p < 0.01 ) , more days of drainage ( 10.3 ± 5.3 vs. 6.2 ± 2.7 , p < 0.01 ) , and later postoperative day of discharge ( 12.8 ± 5.1 days vs. 9.2 ± 4.0 days , p < 0.02 ) than did patients who started motion on day 7 . Wound complications including infection and small areas of skin breakdown occurred more frequently in the early group ( seven patients vs. one patient , p < 0.02 ) . No significant differences in the per cent of patients achieving functional ROM could be identified between these two groups at one , three or six months after operation . Transient serratus anterior palsy ( 12 patients ) and latissimus dorsi palsy ( 2 patients ) occurred in approximately 30 % of all patients , regardless of group ( breast vs. melanoma , early vs. delayed ) , but returned to normal in all patients . The early institution of flexion and abduction exercises following axillary dissection thus appears to have a deleterious effect on wound healing and drainage . Adequate functional ROM is attained in all patients with a minimum of complications when active motion exercises are delayed for up to 7 days after axillary dissection A prospect i ve clinical trial was conducted to determine the effect of axillary node dissection for breast carcinoma on shoulder function and seroma production . 59 Operations were carried out in 57 patients . The patients were divided into two groups . In group A , shoulder exercises were started , under the guidance of a physiotherapist , immediately following surgery , and in group B the exercises were begun on the seventh postoperative day . A full range of motion within six months was achieved in 25 patients of group A ( 81 % ) and in 22 of group B ( 79 % ) . There was no significant difference in wound drainage between the two groups . Restricted shoulder movement was often seen after local wound complications following axillary radiotherapy or after seriously disturbed wound healing A r and omized prospect i ve clinical trial has been performed to determine the effect of temporary immobilization of the shoulder on wound drainage followitig radical mastectomy . In 64 patients admitted to the trial the mean volume of drainage was reduced by 40 per cent in those who had shoulder movement restricted for the first 7 days afer operation when compared with the group in whom early arm exercises were encouraged . The mean drainage time was reduced by 29 per cent . Shoulder immobilization did not result in increased shoulder stiffness , although there was an increased incidence of mild lymphoedema of the arm OBJECTIVE To determine if postoperative shoulder immobilization decreases the incidence of postmastectomy seromas . DESIGN AND SETTING A prospect i ve r and omized trial of three surgeons ' experiences at a community hospital . PATIENTS Thirty-eight patients who underwent modified radical mastectomy from March 1991 through February 1993 . MAIN OUTCOME MEASURES Incidence of postmastectomy seromas and time required for patients to gain 110 degrees of shoulder abduction after surgery . RESULTS Thirteen ( 72 % ) of 18 wounds in the maximum range of motion cohort developed seromas ( 72 % ) compared with one ( 6 % ) of 17 in the minimum range of motion cohort ( P = .0005 ) . The average time required for the patients with maximum range of motion to gain 110 degrees of shoulder abduction was 2.6 weeks , whereas the patients with minimum range of motion required an average of 5.0 weeks ( P = .0127 ) . CONCLUSION Postmastectomy shoulder immobilization significantly decreases the incidence of wound seromas . Although this protocol result ed in a delay in return to normal shoulder mobility , no patients sustained long-term musculoskeletal dysfunction After biopsy confirmation of breast carcinoma , women who were scheduled to undergo a modified radical mastectomy had demographic data collected , goniometric measurements of shoulder flexion and abduction , and functional evaluation of the ipsilateral shoulder performed , and upper extremity circumferential measurements at five levels determined . Patients were then r and omly assigned either to a group that received immediate postoperative physical therapy or to one that did not . Results represent the combination of data from a pilot study and this subsequent study following appropriate statistical analysis . Sixty-four women in the treatment group showed a statistically significant increase in shoulder range of motion in both abduction and flexion as compared to 51 women who received no physical therapy . The treated group also had fewer problems with five of the six upper extremity functional tasks that were assessed . There were no significant differences between the groups for length of hospital stay , postoperative complications , or upper extremity edema . The authors conclude that early physical therapy intervention makes a significant contribution to return to normal function without increasing the incidence of postoperative complications or prolonging hospital stay Background Wound seroma is one of the most frequent complications of mastectomy , but an effective strategy Tor its prevention has not yet been established . The purpose of this study was to determine the effectiveness of delayed shoulder exercise on the prevention of wound seroma after partial or total mastectomy with axillary dissection for the treatment of cancer . Methods This study prospect ively r and omized two exercise schemes after mastectomy with axillary lymph node dissection . The immediate exercise group ( n=58 ) started shoulder exercise on the first postoperative day . In the delayed exercise group ( n=58 ) the movement of the upper limb was limited to usual daily activities during the first postoperative week . Results Preoperative levels of shoulder function were regained within one month when shoulder exercise was delayed for one week after operation . Significant decrease of drainage volume and lower incidence of seroma formation were seen in the delayed exercise group . Conclusion These observations suggest that seven days of unrestricted movement and avoiding active exercise of the shoulder joint , is the optimal routine reduce seroma formation after mastectomy BACKGROUND There are several factors those contribute to the amount of axillary drainage after modified radical mastectomy . The drains should be removed as early as possible . Whether the active shoulder movement of the lesion side increases the amount of axillary drainage needs to be studied prospect ively . METHODS From 1994 through 1995 , 344 consecutive patients were r and omly divided into three groups . One hundred sixteen patients in the early group performed upper arm exercises including pendulum , wall climbing and pulley exercises beginning the third post-operative day . One hundred fifteen patients in the later group patients did the same exercises beginning the sixth post-operative day and 113 patients in the delayed group did the same exercises after all the drains were removed . RESULTS There were no significant differences in patient characteristics , including age , body weight , operation methods and the pathology in the three groups . The amount of axilla fossa drainage was significantly less in the patients in the delayed group than in the early and later group ( 485 ml , 568 ml , 559 ml , respectively , p = 0.032 ) . However , there were no differences in the amount of chest wall site drainage or the number of aspiration of seroma among the three groups . The drains were removed on the average of seventh and ninth post-operative day in the delayed and early group patients , respectively ( p = 0.124 ) . Although the range of motion ( ROM ) of the shoulders in the delayed group patients was slightly limited during the first month after operation , ROM returned at 3 months and no difference was found 6 months after operation . CONCLUSION Upper arm exercise can start after the drains in the axilla are removed . The delay does not limit the shoulder function at 6 months after modified radical mastectomy A prospect i ve r and omized study was carried out to discover the influence of the timing of shoulder physiotherapy after-axillary dissection for breast cancer upon the incidence and duration of lymphatic fluid production and seroma after these operations . Sixty-eight patients underwent a modified radical mastectomy , 31 were su bmi tted to early physiotherapy and 37 to delayed physiotherapy after removal of the suction drainage . In 32 patients this surgery was conservative of the breast ; in 16 the physiotherapy was early and in 16 delayed . The shoulder was left free when the physiotherapy was delayed . The mean volume of lymphatic fluid produced after these 100 axillary dissections was 437 cc ( range : 50 to 800 cc ) with a mean duration of 6.3 days ( range : 2 to 11 days ) . There was a linear relation between the volume and the duration of the lymphatic fluid production . This volume was significantly higher in radical mastectomy than in conservative procedures ( 486 cc vs 333 cc - p less than 0.02 ) . There was no significant difference in the production of lymphatic fluid with early or delayed physiotherapy , whatever the group of patients : radical or conservative surgery - age - number of excised lymph nodes - lymph node involvement . Five seromas occurred in patients with delayed physiotherapy . Delaying physiotherapy after axillary dissection for breast cancer does not seem to reduce the incidence of lymphatic complication , but the use of a conservative procedure rather than a modified radical mastectomy seems to be able to do so Greater amount and duration of postoperative wound drainage after lymphadenectomy impede healing . We evaluated the influence of early vs delayed initiation of shoulder mobilization on postoperative drainage . Fifty-seven women with clinical stage I or II breast cancer were r and omized to either early ( postoperative day 2 ) or delayed ( postoperative day 5 ) shoulder motion . Early vs delayed time of exercise initiation had no effect on total amount or duration of drainage , either as an inpatient or outpatient . The two groups were determined to be homogeneous as to age , breast size , weight , height , obesity , previous biopsy , excision of pectoralis minor , excision of thoracodorsal complex , level of axillary dissection , total number of lymph nodes , number of positive lymph nodes , lymphatic vessel invasion ( with negative lymph nodes ) , and whether the dominant h and was on the side operated on . The two factors predicting greater drainage were large numbers of positive lymph nodes and no previous surgical biopsy ( as in one-step procedure ) A total of 144 evaluable patients with breast cancer were enrolled in a multicenter , r and omized Output:

No significant differences were found for drainage volume or hospital stay . Conclusion Current evidence from RCTs supports the use of a delayed program of arm exercises to reduce seroma formation . Clinical and statistical inconsistencies between studies did not allow any conclusions to be drawn regarding the effects of delayed exercises on fluid drainage , hospital stay and immediate or long term ability to move the arm

MS2_1shot577

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Although the Kasai operation is still the treatment of choice for infants with biliary atresia , the long-term success rate , as defined by survival without transplantation , is only about 25–40 % . It has been proposed that post-operative inflammatory changes affect the bile flow and eventually lead to cholangitis and liver failure . Recent case reports have suggested that the administration of steroids post-operatively can improve outcomes . Since 2004 , our unit has adopted a strict protocol for the use of post-operative steroids for patients who undergo Kasai operation . The aim of this study is to access the early outcomes of these patients . A retrospective analysis was carried out for all patients who received Kasai operation between 1996 and 2006 . For the treatment group , patients all received prednisolone at 4 mg/kg 1 week after operation as guided by protocol . The demographics and outcomes , including post operative bilirubin level , episodes of cholangitic attack , the need for early liver transplantation ( transplant within 1 year of Kasai ) , and transplantation-free survival , were noted . Statistical analysis was done using Fisher ’s exact test and unpaired t-test when appropriate . A value of P < 0.05 was considered to be statistically significant . Kasai operation was performed in 30 patients ( 11 boys and 19 girls ) during the study period . Thirteen patients received post-operative prednisolone according to protocol . The average age at operation and the mean preoperative bilirubin levels for the steroid and non-steroid group were not significantly different . A normal post-operative bilirubin ( defined as bilirubin level less than 20 μmol/L ) was achieved at 6 months in 7 ( 53.9 % ) patients who received steroid and 8 ( 47.0 % ) patients who did not ( P = 0.71 ) . A statistically significant reduction in the post-operative bilirubin level was also seen at 3 and 6 months in the steroid group . Early liver transplantation was required in 5 ( 38.5 % ) patients with steroid and 5 ( 29.4 % ) patients without it ( P = 0.60 ) . No significant difference in terms of cholangitic attack was observed . There was also no steroid-associated complication reported . We conclude that lower post-operative bilirubin level can be achieved with the routine use of prednisolone . However , there is no statistical improvement in terms of early liver transplantation and cholangitis . This may be attributed to the small sample size of our study population . Based on this pilot study , a multi-centre r and omized trial is needed OBJECTIVE : Postoperative adjuvant steroid treatment is reported to improve jaundice-free survival in biliary atresia ( BA ) patients and to reduce the need for early liver transplantation . However , evidence of all retrospective studies is very limited , although high-dose corticosteroids were favored . The aim of this dosage finding study was to test the most promising corticosteroid protocol in a smaller but representative series , in order to optimize the setting s of upcoming prospect i ve and long-term multicenter studies . METHODS : Our prospect i ve single-center and open-labeled pilot study on high-dose steroids included 49 consecutive BA patients . Basic data of the study group were not different from 29 controls . In the study group , 20 consecutive patients were treated after the Kasai with methylprednisolone ( 10 mg/kg day 1 to 5 and 1 mg/kg day 6 to 28 ) . RESULTS : Overall survival with native liver was 63 % after 6 months and 31 % after 2 yr , with no statistical difference between the study and control groups . After 2 yr , 27 % of all patients were still jaundice-free . With regard to predictive parameters , we found , 6 months after the Kasai , bilirubin < 20 μmol/L as highly sensitive ( 97 % ) and specific ( 93 % ) for jaundice-free survival with native liver . CONCLUSIONS : In contrast to previous reports , this pilot study shows that high-dose steroid pulses after Kasai procedure are not effective in postoperative adjuvant therapy protocol s and should be avoided in upcoming multicenter steroid studies . Therefore , we recommend extended and r and omized multicenter studies to pre-evaluate the supposed effectiveness of alternative steroid protocol s , by comparing , 6 months after the Kasai procedure , the number of patients with normal bilirubin BACKGROUND / PURPOSE Despite improvements in the surgical management of biliary atresia , the long-term incidence of progressive liver failure remains high . Because chronic inflammation involving both bile ducts and liver parenchyma contributes to the pathology , the authors have hypothesized that the liver damage may be altered using immunosuppressive therapy . The aim of this study was to examine the safety and efficacy of long-term steroid therapy in patients with biliary atresia . METHODS A retrospective analysis of all patients with biliary atresia treated with an hepatoportoenterostomy and postoperative steroid therapy at our 3 institutions was undertaken . Patients were treated uniformly with immunosuppressive doses of oral steroids for a minimum of 6 weeks after surgery . RESULTS Twenty-five infants with biliary atresia were treated with steroid therapy . Overall survival rate was 22 patients ( 88 % ) with a mean follow-up period of 50 months . Nineteen patients ( 76 % ) became jaundice free with native liver function . Four patients ( 16 % ) did not respond to treatment and required transplantation . Age less than 12 weeks was a crucial predictor of success of adjuvant steroid therapy . Cholangitis developed in 8 patients ( 32 % ) . There were no complications caused by steroid therapy . CONCLUSIONS Steroid administration at immunosuppressive doses markedly improves the clinical outcome within the first 5 years after surgery as measured by jaundice-free status and survival without liver transplantation when compared with concurrent reports . These results suggest that immunosuppressive therapy is safe and has a positive impact on the clinical course of this disease . However , a r and omized study is needed to ultimately prove such an hypothesis Controversy exists regarding the efficacy of corticosteroids on bile flow after Kasai portoenterostomy in biliary atresia ( BA ) . Fourteen patients who had BA and underwent Kasai portojejunostomy between November 1990 and March 1996 were subject of this study . Corticosteroid therapy ( " blast " type ) was used for inadequate bile drainage . Corticosteroid support was unnecessary in one patient with good bile drainage , and corticosteroids were aggressively used in the remaining 13 patients . Two patients who had no response to an initial blast subsequently responded and now are doing well . The remaining 11 patients responded to corticosteroids with varying degrees . Three had a limited response , and two ultimately underwent liver transplantation . There was one death caused by subdural hematoma . Three had an excellent initial response . However , one subsequently deteriorated because of intractable cholangitis , requiring liver transplantation . Ten survivors with native liver are anicteric with satisfactory growth and quality of life . Aggressive corticosteroid therapy is an important part of the management after Kasai portoenterostomy . The initial response to steroids does not necessarily reflect the final outcome PURPOSE This study tests the hypothesis that steroid administration improves the outcome of biliary atresia ( BA ) by evaluating the efficacy of postoperative steroid use on surgical outcomes in infants with BA . METHODS Steroid use and outcomes in patients with BA were retrospectively analyzed at a tertiary pediatric hospital . Institutional review board approval was obtained . RESULTS Kasai portoenterostomy ( PE ) was performed in 43 patients with BA treated from 1992 to 2004 ( 16 boys and 27 girls ) . Twenty-one PE patients received steroids and 22 did not . Portoenterostomy was successful in 24 patients ( 55.8 % ) with consistent serum bilirubin less than 2 mg/dL. Sixteen ( 66 % ) received postoperative steroids . A normal postoperative bilirubin was achieved at 6 months in 16 ( 76 % ) of 21 patients with steroids compared with 8 ( 37 % ) of 22 in untreated controls ( Fisher 's Exact test , P = .01 ) . Of the 43 patients , 19 ( 44 % ) required liver transplantation , including 7 ( 37 % ) of 19 with steroids vs 12 ( 63 % ) of 19 without ( P = .2 ) . Twenty-eight infants developed cholangitis ( fever with and without changes in hepatic function ) : 25 after PE and 3 after transplant . Of the 25 , 12 ( 48 % ) received steroids . Seven died ( 16 % ) ( range , 7 months to 4 years ) : 2 while awaiting transplantation ( received steroids ) and 5 after transplantation ( 1 received steroids and 4 were untreated ) . Survival was 86 % ( 18/21 ) in patients with steroids and 82 % ( 18/22 ) in those without . Transplant survival ( 74 % ) was comparable to previously reported historical controls ( 82 % ) . CONCLUSIONS The Kasai PE continues to be the procedure of choice in infants with BA younger than 3 months . A significantly improved clearance of postoperative jaundice and lower serum bilirubin levels were observed in patients receiving steroids . However , steroids had no effect on the incidence of cholangitis , need for liver transplantation , and overall survival . A prospect i ve study with st and ardized dose and length of steroid administration and longer period of follow-up is necessary to more accurately assess the effectiveness of steroids after PE The objective of this study was to evaluate adjuvant corticosteroids after Kasai portoenterostomy for biliary atresia . The study consisted of a prospect i ve , 2‐center , double‐blind , r and omized , placebo‐controlled trial of post – Kasai portoenterostomy corticosteroids ( oral prednisolone : 2 mg/kg/day from day 7 to day 21 and 1 mg/kg/day from day 22 to day 28 ) . The data were compared with χ 2 or Mann‐Whitney tests , as appropriate . Seventy‐one postoperative infants with type 3 biliary atresia were r and omized to receive either oral prednisolone ( n = 36 ) or a placebo ( n = 37 ) . At 1 month , the median bilirubin level was lower in the steroid group ( 66 versus 92 μmol/L , P = 0.06 ) , but no difference was evident at 6 ( P = 0.56 ) or 12 ( P = 0.3 ) months . The proportion of infants with a normal bilirubin level ( < 20 μmol/L ) at 6 ( 47 % versus 49 % , P = 0.89 ) and 12 months ( 50 % versus 40 % , P = 0.35 ) was not significantly different . The need for transplantation by 6 ( 12 % versus 13 % , P = 0.99 ) and 12 months ( 26 % versus 35 % , P = 0.47 ) was not significantly different . The steroid effect was more pronounced in younger infants ( less than 70 days at Kasai portoenterostomy , n = 51 ) , with a reduced bilirubin level at 1 month ( 64 versus 117 μmol/L , P = 0.01 ) and with a greater proportion with a normal bilirubin level at 12 months ( 54 % versus 37 % , P = 0.22 ) . Conclusion : There was a beneficial effect on the rate of reduction of bilirubin in the early postoperative period ( specifically in infants less than 70 days old at surgery ) , but this steroid regimen did not reduce the need for liver transplantation . ( HEPATOLOGY 2007;46:1821–1827 . Output:

The present meta- analysis did not find a significant effect of steroid over st and ard therapy , either in normalizing serum bilirubin levels at six months or at delaying the need for early liver transplantation post-KP .

MS2_1shot578

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results The prevalence rate of ascariasis in primary school children in northern Jakarta , Indonesia varies from 60 % to 90 % . An association between helminthic infection and educational achievement has long been recognized . This study was carried out in the northern part of Jakarta among primary school children 6 - 8 years of age . Treatment of ascariasis and health education were used as the interventions . Before the interventions , basic data on socioeconomic status , epidemiology , infection with Ascaris lumbricoides , nutritional status , and cognitive function were collected . After the interventions , only data on infection with A. lumbricoides , nutritional status , and cognitive function were collected . The children were divided into five groups . Group I was given an anthelminthic ( mebendazole ) , group II was provided with health education , group III was given an antihelminthic and provided with health education , group IV was given a placebo ( controls ) , and group V consisted of egg-negative children , who also served as controls . Data from 336 students were analyzed by analysis of covariance . Parasitologic examinations showed a mean prevalence rate of 58.4 % for A. lumbricoides infection in the pre-intervention children and a mean prevalence rate of 40.6 % in the post-intervention children . Concerning nutritional status , approximately 80 % of the children showed good scores in the pre- and post-treatment data , and only a small percentage ( 0.9 - 16.2 % ) showed mild or moderate malnutrition . No significant difference was found between the pre- and post-treatment nutritional status . The results of the cognitive test showed that the group treated with mebendazole showed significant improvement in the Colored Progressive Matrices and Coding test . Children also showed an improvement in their learning ability , concentration , and eye-h and coordination after five months of receiving this intervention BACKGROUND The effect of helminth infestation on the nutrition , growth , and physiology of the host is still poorly understood . Anthelmintic treatment of children in developing countries has had varying success in terms of growth improvements . OBJECTIVE The objective of this study was to assess the effect of regular deworming on child growth , physiology , and biochemical status . DESIGN The study was a 12-mo longitudinal intervention in 123 Bangladeshi children aged 2 - 5 y. Treatment ( mebendazole ) or placebo tablets were administered every 2 mo for 8 mo and again at 12 mo . Weight , height , midupper arm circumference , intestinal permeability , plasma albumin , alpha(1)-antichymotrypsin , and total protein concentration were assessed every 2 mo . RESULTS Treatment with mebendazole reduced the prevalence of Ascaris lumbricoides from 78 % to 8 % , of Trichuris trichiura from 65 % to 9 % , and of hookworm from 4 % to 0 % . There was no significant difference in the growth of treated children compared with those given placebo tablets . No changes in intestinal permeability or plasma albumin were observed after deworming . Significant decreases in total protein ( P<0.001 ) and alpha(1)-antichymotrypsin ( P<0.001 ) were observed in the treatment group , indicating possible reductions in inflammation and immunoglobulin concentration after deworming . A significant increase in the prevalence of Giardia intestinalis ( from 4 % to 49 % ) in the treatment group was associated with a short-term reduction in weight ( P = 0.02 ) and higher intestinal permeability ( P < 0.001 ) in infected subjects . No long-term effects of G. intestinalis on growth were observed . CONCLUSION Low-intensity helminth infections , predominantly of A. lumbricoides and T. trichiura , do not contribute significantly to the poor growth and biochemical status of rural Bangladeshi children We studied growth in infected children given one dose ( 600 mg ) or two doses of albendazole per school year . Children were examined and allocated at r and om within sex by descending hookworm egg count to one of three groups : placebo ( n = 93 ) , one dose ( 1x , n = 96 ) or two doses ( 2x , n = 95 ) . Each child was treated and then re-examined and treated 3.6 and 8.2 mo later ( Exams 2 and 3 ) . The 1x and 2x groups gained significantly more by Exam 3 than the placebo group in weight ( 1.1 and 0.9 kg more , respectively ) , percent weight-for-age ( 3.3 and 2.7 percentage points more ) , percent weight-for-height ( 3.1 and 2.9 percentage points more ) , percent arm circumference-for-age ( 2.3 and 2.0 percentage points more ) and triceps and subscapular skinfolds but did not differ significantly from each other . The placebo group showed significant decreases between exams ( P < 0.0002 ) in percent weight-for-age and percent arm circumference-for-age and no change in percent weight-for-height , whereas the 1x and 2x groups exhibited significant increases ( P < 0.005 ) . At Exam 3 , arithmetic mean egg reduction rates for the 1x and 2x groups were 84 and 95 % for hookworm , 42 and 32 % for Trichuris and 55 and 87 % for Ascaris , respectively . We conclude that one or two doses of albendazole per year result ed in similar growth improvements , despite reinfection , in school-age children in an area where these helminths and poor growth are prevalent We studied physical fitness with the Harvard Step Test , growth , and appetite in primary school boys infected with hookworm ( 96 % baseline prevalence ) , Trichuris trichiura ( 98 % prevalence ) and Ascaris lumbricoides ( 41 % prevalence ) who received a single 600-mg dose of albendazole or an identical placebo . Boys were examined , allocated at r and om within pairs by descending hookworm egg count to placebo ( n = 26 ) or albendazole ( n = 27 ) groups , treated , and re-examined 4 mo later . Four months after treatment , the albendazole group showed highly significant improvements in fitness score , resting heart rate , and heart rates at 1 , 2 , 3 and 4 min after the Harvard Step Test , whereas the placebo group had not changed significantly . The albendazole group also exhibited significantly more rapid growth judged by weight gain ( 1.0 kg greater than the placebo group , P < 0.0002 ) , height increment ( 0.6 cm more , P < 0.003 ) , arm circumference ( 0.3 cm more , P < 0.0002 ) , and triceps and subscapular skinfolds ( 1.0 mm more , P < 0.0002 ) , and showed improved appetite with objective and subjective measures . We conclude that single-dose treatment with albendazole can allow improved physical fitness , growth , and appetite in school-age children in areas where these helminths and poor growth are highly prevalent A r and omized controlled trial was conducted in eastern Zaire to assess the effects of high dose vitamin A supplementation and regular deparasitation on the growth of 358 moderately malnourished preschool children , discharged from the hospital . The treatment groups received either vitamin A ( 60 mg of oily solution of retinyl palmitate , 30 mg if aged < 12 mo ) every 6 mo or mebendazole ( 500 mg ) every 3 mo ; the control group received no supplementation . Anthropometric data were gathered at baseline and after 6 and 12 mo of follow-up . Serum retinol concentrations were measured at baseline and after 3 mo . The three groups did not differ in sociodemographic indicators , age and sex composition , nutritional status and serum retinol concentrations at baseline . In children who were vitamin A deficient at baseline , adjusted mean weight and mid-upper arm circumference ( MUAC ) increments were higher in the vitamin A-supplemented group than in the control group [ annual increment in weight and MUAC in vitamin A vs. control group : 2.088 vs. 1.179 kg ( P = 0.029 ) and 2.24 vs. 0.95 cm ( P = 0.012 ) , respectively ] , whereas growth increment did not differ between the dewormed group and the control group . In children who were not vitamin A deficient at baseline , growth increment did not differ between the vitamin A-supplemented and control groups , whereas weight gain was lower in the dewormed group than in the control group . Vitamin A-supplemented boys gained more weight and height than control boys , whereas vitamin A-supplemented girls gained less height than control girls . Dewormed boys and girls gained less weight than control boys and girls . Programs to improve vitamin A status by high dose vitamin A supplementation may improve growth of preschool children who are vitamin A deficient , whereas deworming does not Efficacy trials of antihelminthic therapies conducted in Africa have reported improvements in children 's growth , but nutritional evaluations of large-scale deworming programs are lacking . We evaluated the first-year effect on growth of a school-based deworming program in Zanzibar , where growth retardation occurs in school children . Children in four primary schools were given thrice-yearly mebendazole ( 500 mg ) and compared with children in four schools that received twice-yearly mebendazole and children in four non-program schools . Evaluation schools were r and omly selected and allocated to control , twice-yearly or thrice-yearly deworming . Approximately 1000 children in each program group completed the 1-y follow-up . Children < 10 y old gained 0.27 kg more weight ( P < 0.05 ) and 0.13 cm more height ( P = 0.20 ) in the twice-yearly group , and 0 . 20 kg more weight ( P = 0.07 ) and 0.30 cm more height ( P < 0.01 ) in the thrice-yearly group , compared with the control group . Children < 10 y old with higher heights-for-age at baseline had higher weight and height gains in response to deworming . In children > /=10 y old , overall program effects on height or weight gains were not significant . But in this age range , younger boys had significant improvements in height gain with thrice-yearly deworming , and children with higher heights-for-age had greater improvements in weight gain with deworming . We conclude that the deworming program improved the growth of school children , especially children who were younger and less stunted , but the improvements were small . More effective antihelminthic regimens or additional dietary or disease control interventions may be needed to substantially improve the growth of school children in areas such as Zanzibar We evaluated the effects of the Zanzibar school-based deworming program on the iron status of primary school children . Parasitologic and nutritional assessment s were carried out at baseline , 6 mo , and 12 mo in 4 nonprogram schools ( n = 1002 ) , 4 schools in which students received twice-yearly deworming ( n = 952 ) , and 4 schools in which students received thrice-yearly deworming ( n = 970 ) with 500 mg generic mebendazole . Schools were r and omly selected for evaluation and allocated to program groups . Relative to no treatment , thrice-yearly deworming caused significant decreases in protoporphyrin concentrations and both deworming regimens caused marginally significant increases in serum ferritin concentrations . The average annual changes in protoporphyrin concentrations were -5.9 and -23.5 micromol/mol heme in the control and thrice-yearly deworming groups , respectively ( P < 0.001 ) . The average changes in ferritin concentration were 2.8 and 4.5 microg/L , respectively ( P = 0.07 ) . Deworming had no effect on annual hemoglobin change or prevalence of anemia . However , the relative risk of severe anemia ( hemoglobin < 70 g/L ) was 0.77 ( 95 % confidence limits : 0.39 , 1.51 ) in the twice-yearly deworming group and 0.45 ( 0.19 Output:

AUTHORS ' CONCLUSIONS Deworming drugs used in targeted community programmes may be effective in relation to weight gain in some circumstances but not in others . No effect on cognition or school performance has been demonstrated

MS2_1shot579

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : To identify the effects of substance abuse status ( active , former , and never ) on utilization of highly active antiretroviral therapy ( HAART ) , medication adherence , and virologic and immunologic responses to therapy . Design : Prospect i ve cohort study of 764 HIV‐1‐infected patients who attended an urban HIV clinic and participated in a st and ardized interview . Main Outcome Measures : Past utilization of HAART , self‐reported nonadherence with antiretroviral therapy , and changes in HIV‐1 RNA level and CD4 + lymphocyte count relative to prior peak and nadir , respectively . Results : Forty‐four percent of active drug users failed to utilize HAART compared with 22 % of former drug users and 18 % of non‐drug users ( p < .001 for both comparisons ) . Among participants who were taking antiretroviral therapy when interviewed , active drug users were more likely to report medication nonadherence ( 34 % vs. 24 % of nonusers and 17 % of former users ) , had a smaller median reduction in HIV‐1 RNA from baseline ( 0.8 log10 copies/ml vs. 1.7 in nonusers and 1.6 in former users ) , and had smaller median increases in CD4 + lymphocyte count from baseline ( 65 cells/mm3 vs. 116 in nonusers and 122 in former users ) ( p < .05 for all comparisons with active users ) . Conclusions : Active drug use was strongly associated with underutilization of HAART , nonadherence , and inferior virologic and immunologic responses to therapy , whereas former drug users and non‐drug users were similar in all outcomes . Effective strategies are needed that integrate HIV‐1 and substance abuse treatments Directly administered antiretroviral therapy ( DAART ) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users . We evaluated the essential features of a community-based DAART intervention in a r and omized , controlled trial of DAART versus self-administered therapy . Of the initial 72 subjects , 78 % were racial minorities , and 32 % were women . Social and medical comorbidities among subjects included homelessness ( 35 % of subjects ) , lack of interpersonal support ( 86 % ) , major depression ( 57 % ) , and alcoholism ( 36 % ) . At baseline , the median CD4 + cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL ( log10 5.31 copies/mL ) . During the prior 6 months , 33 % of subjects had missed a medical appointment , and 47 % had visited an emergency department . Although most subjects ( 67 % ) preferred to take their own medications , 76 % would accept DAART if it were made compulsory . A methadone clinic was the DAART venue acceptable to the fewest subjects ( 36 % ) , and a mobile syringe-exchange program was acceptable to the most subjects ( 83 % ) . Adherence was higher for supervised than for unsupervised medication administration ( P<.0001 ) , a finding that supports use of daily supervision of once-daily regimens . Moreover , DAART should incorporate enhanced elements such as convenience , flexibility , confidentiality , cues and reminders , responsive pharmacy and medical services , and specialized training for staff To evaluate the impact of injection drug users ( IDUs ) adherence on effectiveness of highly active antiretroviral therapy ( HAART ) , repeated measures of plasma viral load and CD4 + counts before HAART initiation and at last visit in the cohort were studied . Data were collected by means of patient 's face-to-face and self-administered question naires about adherence to HAART during the week prior to the last visit . Of a total of 119 patients treated with HAART , undetectable viral load was obtained for 55 patients ( 46.2 % ) ( G3 ) ; 34 patients ( 28.6 % ) ( G2 ) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort , while 30 patients ( 25.2 % ) ( G1 ) had no decline or decline ≤ 0.5 log copies/ml . Proportion of 100 % adherent patients was significantly higher in G3 ( 83.6 % ) than in G2 ( 64.7 % ) and G1 ( 56.7 % ) . In spite of differences in virological success and adherence , mean increase in CD4 + counts was similar in G3 ( 123 ± 160 counts/mm3 ) and G2 ( 143 ± 147 ) while no immunological improvement was observed in G1 . For the sub-groups of patients whose limited adherence has implied virological failure but did not impede short-term immunological reconstitution following HAART initiation , decision to switch HAART regimens could be delayed until interventions for improving future adherence have been carried out Objective To assess the temporal association of changes in substance abuse with antiretroviral therapy use and adherence , HIV-1 RNA suppression , and CD4 cell count changes in patients attending an urban clinic . Design Prospect i ve cohort study . Methods Six-hundred and ninety-five HIV-1-infected individuals , who completed two or more semi-annual st and ardized surveys and in whom antiretroviral therapy was indicated , were included in the analysis . Surveys addressed antiretroviral therapy use and adherence , and use of illicit drugs and alcohol . Substance abuse was defined as active heroin , cocaine , or heavy alcohol use in the 6 months preceding survey . The units of analysis were consecutive pairs of surveys ( couplets ) in individual participants . Couplets in which participants denied substance abuse in both surveys were compared to couplets in which participants switched from non-use to substance abuse , and couplets in which participants reported substance abuse in both surveys were compared to couplets where participants switched from substance abuse to non-use . Results Switching from non-use to substance abuse was strongly associated with worsening antiretroviral therapy use and adherence , less frequent HIV-1 RNA suppression , and blunted CD4 cell increases , compared to remaining free of substance abuse . Alternatively , switching from substance abuse to non-use was strongly associated with improvements in antiretroviral therapy use and adherence , and HIV-1 treatment outcomes , compared to persisting with substance abuse . Conclusions This longitudinal study highlights the dynamic nature of substance abuse and its temporal association with the effectiveness of HIV-1 treatment in patients attending an inner-city clinic This study assesses changes in quality of life ( QoL ) over time among HIV-infected individuals receiving antiretroviral therapy ( ART ) and evaluates how this relates to ART adherence . Prospect i ve , longitudinal data were examined from 1050 participants in two large , r and omized , multi-centre antiretroviral clinical trials . QoL was assessed by the SF-12 ; adherence by the Terry Beirn Community Programs for Clinical Research on AIDS Antiretroviral Medication Self-report . Participants included 20 % women , 53 % African Americans , 16 % Latinos ; mean age was 39 years ; mean baseline CD4 + cell count 230 cells/mm3 ; 89 % were ART-naïve at entry . Baseline physical and mental health summary QoL scores were 45.4 and 42.9 , comparable to scores reported in other advanced HIV population s. Significant improvements in mean QoL scores were seen for the group as a whole after 1 to 4 months on new ART regimens , and persisted for 12 months . Participants reporting 100 % ART adherence achieved significantly higher QoL scores at 12 months compared to those with poorer adherence , particularly if 100 % adherence was consistent ( p<0.001 ) . Those with at least 80 % ART adherence had smaller gains in QoL at 12 months when compared to baseline , while those with < 80 % adherence had worsening of QoL. In this analysis , ART adherence was associated with improved QoL , particularly if adherence was sustained Improved therapeutic strategies , including the introduction of protease inhibitors , have led to a striking decrease in HIV-related morbidity and mortality ( 1 , 2 ) . It is widely believed that adherence to an antiretroviral regimen is central to the likelihood that a patient will derive sustained benefit from therapy ( 3 , 4 ) . Conventional wisdom holds that two groups of patients are currently experiencing clinical and virologic failure . The first group consists of patients who have received multiple different antiretroviral drugs over a prolonged period of time and who may be infected predominantly with HIV strains that are resistant to multiple drugs . The second group comprises patients who adhere poorly to their antiretroviral regimen . The two groups are not mutually exclusive : Patients with suboptimal adherence may be more likely to have antiretroviral drugresistant HIV infection . The potential public health importance of adherence to therapy in prevention of transmission of drug-resistant virus has also been emphasized ( 5 ) . Patients with suboptimal adherence to antiretroviral therapy and poor adherence to use of safer-sex practice s , such as use of condoms , may infect others with their own antiretroviral drugresistant virus . Anecdotal experience suggests that physicians may be unwilling to prescribe combination antiretroviral therapy to patients whom they perceive to be at high risk for poor adherence ( 6 ) . Given the critical importance of adherence to therapy to patient outcome , secondary prevention of HIV infection , and willingness of providers to prescribe therapy , we prospect ively investigated the association between protease inhibitor adherence and patient outcome , factors related to adherence , and the accuracy of physicians ' prediction of patient adherence . We used a microelectronic monitoring system to assess adherence to antiretroviral therapy . Methods Study Sample The study was conducted at the HIV clinics of the Veterans Affairs Medical Center , Pittsburgh , Pennsylvania , and University of Nebraska Medical Center , Omaha , Nebraska . The HIV physicians at these clinics were primary care providers for the study patients . Each site also had a dedicated HIV nurse coordinator . From August 1997 to March 1999 , we enrolled consecutive patients with HIV infection who were already receiving a protease inhibitor ( experienced patients ) or who were to begin taking a protease inhibitor ( naive patients ) . Exclusion criteria were inability to give informed written consent ; expectation of continued use of a medication organizer to include protease inhibitors ; and residence in a nursing home , jail , or hospice , where medications were dispensed at least daily . Collection of Baseline Data At baseline , a study investigator used medical chart review to complete a 52-item question naire for each patient . The question naire covered demographic information ( age , sex , ethnicity , risk factors for HIV infection , educational and employment status , income ) , medical history ( years known to be HIV infected ; opportunistic infections ; history of schizophrenia , depression , or bipolar affective disorder ) , and medication use ( name , dose , and frequency of all antiretroviral agents , other antimicrobials , and other prescription therapies ) . The enrolling physician assessed use of illegal drugs and nonprescription therapies ( including herbal or alternative therapies ) by interview . Alcohol abuse was assessed by using the CAGE question naire ( cutting down , annoyance with criticism , guilty feelings , and use of eye-opener drinks ) ( 7 ) . Information about use of adherence aids ( such as personal reminders by significant others or timers , alarms , or other devices ) was specifically sought . The investigator asked study patients if they felt that their current symptoms were attributable to HIV infection , the antiretroviral medications , or both . In addition , patients were asked whether they agreed with such health beliefs as Do you think your antiretroviral therapy will make you live longer ? At baseline , each patient completed the Beck Depression Inventory and the General Health Question naire ( 8 , 9 ) , well-vali date d measures of psychiatric morbidity that have been widely used in patients with HIV infection ( 9 - 11 ) . Patients completed the inventories as a written task without the assistance of a physician or clinic nurse . At baseline , we used the following question to elicit a prediction of adherence to protease inhibitor therapy from the patient 's primary HIV physician and clinic nurse : Do you think that the patient is compliant with antiretroviral therapy , that is , taking greater than 80 % of the prescribed doses of antiretroviral medications ? This prediction was made after collection of the baseline information but before actual measurement of adherence using the microelectronic monitoring system had begun . Collection of Follow-up Data Every 3 months for the duration of the study , the study participants were asked whether any of the following had changed since their previous visit : employment , use of alcohol or illegal drugs , residence , attribution of symptoms to the antiretroviral therapy or HIV infection , and changes in medications . Patients completed a new Beck Depression Inventory and General Health Question naire . The primary HIV physician determined whether the patient had developed an opportunistic infection in the past 3 months . Laboratory Testing At baseline and every 3 months for the duration of the study , HIV RNA levels were measured by using the Roche Amplicor System ( Roche Diagnostics , Nutley , New Jersey ) and CD4 lymphocyte sub population assays were performed . Assessment of Ad Output:

Overall , active substance use was associated with poor adherence , as well as depression and low social support . Higher adherence was found in patents receiving care in structured setting s ( e.g. directly observed therapy ) and /or drug addiction treatment ( especially substitution therapy ) . While lower than other population s-especially among users of stimulants , incarcerated DU and patients with psychiatric comorbidities-adherence to HAART among HIV-positive DU can be achieved . Better adherence was identified among those engaged in comprehensive services providing HIV and addiction treatment with psychosocial support

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Clinical observations have suggested a relationship between shoulder range of movement ( ROM ) and lateral epicondylalgia . This study reports the effect of a single intervention of a mobilization with movement ( MWM ) applied to the elbow , on shoulder rotation ROM in subjects with lateral epicondylalgia . Twenty-three subjects with lateral epicondylalgia were included . In a one-group pretest-post-test design , ROM of shoulder internal and external rotation were measured by goniometer before and after the application of the MWM , of both the unaffected and the affected limbs . Significant differences in pre-intervention external rotation ROM were found between unaffected and affected shoulders of subjects with lateral epicondylalgia , but no significant difference remained post-intervention . It may be concluded that restriction of shoulder rotation ROM is present in patients with lateral epicondylalgia , probably due to a facilitated level of shoulder rotator muscle tone . Shoulder internal and external rotation ROM increases significantly following MWM to the elbow , in subjects with unilateral lateral epicondylalgia . Surprisingly , these ROM increases are also apparent on the ' unaffected ' limb . These findings suggest that the MWM causes a neurophysiologically mediated decrease in resting muscle tone BACKGROUND AND PURPOSE In many physical therapy programs for subjects with adhesive capsulitis of the shoulder , mobilization techniques are an important part of the intervention . The purpose of this study was to compare the effectiveness of high- grade mobilization techniques ( HGMT ) with that of low- grade mobilization techniques ( LGMT ) in subjects with adhesive capsulitis of the shoulder . SUBJECTS One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or = 50 % decrease in passive joint mobility relative to the nonaffected side were enrolled in this study . METHODS Subjects r and omly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint , and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone . The duration of treatment was a maximum of 12 weeks ( 24 sessions ) in both groups . Subjects were assessed at baseline and at 3 , 6 , and 12 months by a masked assessor . Primary outcome measures included active and passive range of motion and shoulder disability ( Shoulder Rating Question naire [ SRQ ] and Shoulder Disability Question naire [ SDQ ] ) . An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year , respectively . RESULTS Overall , subjects in both groups improved over 12 months . Statistically significant greater change scores were found in the HGMT group for passive abduction ( at the time points 3 and 12 months ) , and for active and passive external rotation ( at 12 months ) . A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation , SRQ , and SDQ with greater change scores in the HGMT group . DISCUSSION AND CONCLUSION In subjects with adhesive capsulitis of the shoulder , HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs , with the overall differences between the 2 interventions being small PRINCIPLE A r and omised , comparative prospect i ve clinical trial was planned to compare the early response to different rehabilitation methods for adhesive capsulitis taking into consideration the clinical efficacy and the cost effectiveness of the methods . METHODS Forty patients with adhesive capsulitis were r and omised into two treatment groups . The first group ( CYR ) received the Cyriax approach of deep friction massage and mobilisation exercises three times weekly . The second group ( PT ) had daily physical therapy including hot pack and short wave diathermy application . Both groups concluded their treatments with stretching exercises and were also instructed to a daily home exercise program . The primary end point of the study was to reach 80 % of the normal passive range of motion ( ROM ) of the shoulder in all planes within a period of two weeks . Secondary end points were the overall ROM and pain response ( spontaneous pain , night pain and pain with motion ) to each treatment . RESULTS 19 patients in the CYR group ( 95 % ) and 13 patients in the PT group ( 65 % ) reached sufficient ROM at the end of the second week ( p < 0.05 ) . The improvement in shoulder flexion , inner and outer rotation values and the decrease in pain with motion were significantly better in the CYR group after the first week of treatment . CONCLUSION The Cyriax method of rehabilitation provides a faster and better response than the conventional physical therapy methods in the early phase of treatment in adhesive capsulitis . The method is non-invasive , effective and requires fewer hospital visits for a sufficient early response Seventy-seven patients with idiopathic frozen shoulder syndrome were included in a prospect i ve study to compare the effect of intensive physical rehabilitation treatment , including passive stretching and manual mobilization ( stretching group ) versus supportive therapy and exercises within the pain limits ( supervised neglect group ) . There were no significant differences in age , sex , time elapsed since onset , and disease severity at inclusion . All patients were followed up for 24 months after the start of treatment . In the patients treated with supervised neglect , 89 % had normal or near-normal painless shoulder function ( Constant score > or = 80 ) at the end of the observation period . This end result was reached by 64 % within 12 months . In contrast , of the group receiving intensive physical therapy treatment , only 63 % reached a Constant score of 80 or higher after 24 months . Both the level of the Constant score at the end of the study and the moment a Constant score of 80 or higher was reached confirm that supervised neglect yields better outcomes than intensive physical therapy and passive stretching in patients with frozen shoulder Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops , shorten its duration . We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach ( EMSMTA ) in a subgroup of subjects with frozen shoulder syndrome ( FSS ) . Based on the kinematics criteria from a prediction method , 34 subjects with FSS were recruited . Eleven subjects were assigned to the control group , and 23 subjects who met the criteria were r and omly assigned to the criteria -control group with a st and ardized physical therapy program or to the EMSMTA group . Subjects attended treatment sessions twice a week for 8 weeks . Range of motion ( ROM ) , disability score , and shoulder complex kinematics were obtained at the beginning , 4 weeks , and 8 weeks . Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria -control group at 4 weeks ( mean difference=0.2 of normalized h and -behind-back reach ) and 8 weeks ( mean difference=22.4 degrees humeral external rotation , 0.31 of normalized h and -behind-back reach , 7.5 disability , 5 degrees tipping and 0.32 rhythm ratio ) . Similar improvements were found between the EMSMTA group and control group . The EMSMTA was more effective than a st and ardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method OBJECTIVE To evaluate Mulligan 's technique for relieving pain and improving functional capacity of the shoulder in patients with adhesive capsulitis in the stiffness phase . DESIGN R and omized controlled study . METHODS A total of 40 subjects were r and omly allocated into 2 groups : ( i ) group 1 ( n = 20 ) were treated with hot pack , transcutaneous electrical nerve stimulation , and passive stretching exercises ; ( ii ) group 2 ( n = 20 ) were treated with hot pack , transcutaneous electrical nerve stimulation and Mulligan 's technique . Mulligan 's technique combines the sustained application of a manual " gliding " force to a joint , with the aim of repositioning bone positional faults while enabling concurrent physiological ( osteo-kinematic ) motion of the joint . All cases were evaluated using visual analogue scales for pain , passive and active range of motion , Constant score , Shoulder Disability Question naire , and patient and therapist satisfaction at baseline , after completion of treatment sessions and at the end of 3 months of follow-up . RESULTS Marked improvement was noted in both groups after completion of treatment sessions and at the third month of follow-up compared with baseline . The improvements in outcome measures , namely pain , range of motion , shoulder scores , and patient and physiotherapist satisfaction , were significantly greater in subjects in group 2 , who were treated with Mulligan 's technique . CONCLUSION Mulligan 's technique and passive stretching exercises are both effective in reducing pain , and restoring range of motion and function . However , compared with stretching exercises , Mulligan 's technique led to better improvements in terms of pain , range of motion , shoulder scores , and patient and physiotherapist satisfaction Background Adhesive Capsulitis ( AC ) affects patient of all ages , and stretching protocol s are commonly prescribed for this condition . Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis . The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC . Methods This controlled , cohort study , was conducted at four physical therapy , sports medicine clinics in Texas and California . Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention . The intervention categories were as follows : Group I ( Control ) ; Group II ( Physical Therapy exclusively with st and ardized protocol s ) ; Group III ; ( Shoulder Dynasplint system exclusively ) ; Group IV ( Combined treatment with Shoulder Dynasplint and st and ardized Physical Therapy ) . The duration of this study was 90 days for all groups , and the main outcome measures were change in active , external rotation . Results Significant difference was found for all treatment groups ( p < 0.001 ) following a one-way ANOVA . The greatest change with the smallest st and ard deviation was for the combined treatment group IV , ( mean change of 29 ° ) . Conclusion The difference for the combined treatment group was attributed to patients ' receiving the best PT combined with structured " home therapy " that contributed an additional 90 hours of end-range stretching . This adjunct should be included in the st and ard of care for adhesive Capsulitis . Trial Registration Trial Number : OBJECTIVE To determine whether an active physiotherapy program following arthrographic joint distension for adhesive capsulitis provides additional benefits . METHODS We performed a r and omized , placebo-controlled , participant and single assessor blinded trial . A total of 156 participants with pain and stiffness in predominantly 1 shoulder for > or=3 months and restriction of passive motion > 30 degrees in > or=2 planes of movement entered the study , and 144 completed the study . Following joint distension , participants were r and omly assigned to either manual therapy and directed exercise or placebo ( sham ultrasound ) , both administered twice weekly for 2 weeks then once weekly for 4 weeks . Pain , function , active shoulder movements , participant-perceived success , and quality of life were assessed at baseline , 6 , 12 , and 26 weeks . Costs were also collected . RESULTS Both groups improved over time with no significant differences in improvement between groups for pain , function , or quality of life at any time point . Significant differences favored the physiotherapy group for all active shoulder movements ( e.g. , pooled difference in mean change between groups across all time points for total shoulder abduction was 10.6 degrees , 95 % confidence interval [ 95 % CI ] 3.1 , 18.1 ) and participant-perceived success ( pooled relative risk 1.4 , 95 % CI 1.1 , 1.65 ; number needed to treat = 5 ) . Net cost of physiotherapy was $ 136.8 Australian ( 95 % CI -177.5 , 223.1 ) over the 6 months . CONCLUSION Physiotherapy following joint distension provided no additional benefits in terms of pain , function , or quality of life but result ed in sustained greater active range of shoulder movement and participant-perceived improvement up to 6 months OBJECTIVE To determine the efficacy of positioning the affected shoulder in flexion and external rotation to prevent contracture shortly after stroke . DESIGN Prospect i ve , parallel-group , r and omized controlled trial . SETTING Four metropolitan mixed rehabilitation units . PARTICIPANTS A volunteer sample of 36 subjects ( minus 5 dropouts ) , whose mean age was 68 years and had had their first stroke within the past 20 days . INTERVENTIONS The experimental group received two 30-minute sessions a day , 5 days a week , for 4 weeks , during which the affected upper limb was placed in maximum comfortable external rotation and 90 degrees of flexion . Both the experimental and control groups received up to 10 minutes of shoulder exercises and st and ard upper-limb care . MAIN OUTCOME MEASURES Contracture was measured as the maximum passive shoulder external rotation and flexion of the affected side as compared with the intact side . Measures were taken at 2 and 6 weeks after stroke by an assessor blinded to group allocation . RESULTS The 30-minute program of positioning the shoulder in maximum external rotation significantly reduced the development of contractures in the experimental group , compared with the control group ( P = .03 ) . The 30-minute program of positioning the shoulder in 90 degrees of flexion did not prevent contractures in the experimental group as compared with the control group ( P = .88 ) . CONCLUSIONS At least 30 minutes a day of positioning the affected shoulder in external rotation should be started as soon as possible for stroke patients who have little activity in the upper arm Painful stiffening of the shoulder , ‘ frozen shoulder ’ is a common cause of shoulder pain and disability . Continuous passive motion ( CPM ) is an established method of preventing joint stiffness and of overcoming it . A r Output:

Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization ( n=1 ) had a superior effect on active ROM compared with sham ultrasound . CONCLUSIONS Overall , mobilization techniques have beneficial effects in patients with primary AC of the shoulder .

MS2_1shot581

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To determine if the addition of continuous morphokinetic data improves reproductive outcomes when all embryos are cultured in a closed system . DESIGN Prospect i ve , r and omized , controlled study . SETTING Single academic center . PATIENT(S ) A total of 235 patients undergoing fresh autologous IVF cycles with at least four embryos , cultured in the Embryoscope : 116 patients r and omized to conventional once-daily morphologic embryo screening ( CS ) and 119 to additional time-lapse kinetic monitoring ( TLM ) for selection . INTERVENTION(S ) TLM versus CS . MAIN OUTCOME MEASURE(S ) Intrauterine clinical pregnancy ( CPR ) and implantation ( IR ) rates . RESULT ( S ) CPR and IR were similar overall ( TLM vs. CS , respectively : CPR 68 % vs. 63 % ; IR 51 % vs. 45 % ) and with blastocyst transfers ( CPR 74 % vs. 67 % ; IR 56 % vs. 51 % ) . CPR with day 5 transfer was threefold higher than day 3 transfer , but group ( TLM vs. CS ) was not a significant predictor of clinical pregnancy or implantation . Significantly more multinucleation was detected when CS embryos were retrospectively review ed with the use of TLM ( 7.0 % vs. 35.3 % ) , and multinucleation was independently associated with decreased rates of implantation . Time to the start of blastulation of < 100 hours after insemination and the morphokinetic scoring system used in the TLM group were independently associated with implantation . CONCLUSION ( S ) The addition of time-lapse morphokinetic data did not significantly improve clinical reproductive outcomes in all patients and in those with blastocyst transfers . Absence of multinucleation , timing of blastulation , and morphokinetic score were found to be associated with blastocyst implantation rates . CLINICAL TRIAL REGISTRATION NUMBER NCT02081859 Background Previously manual human embryology in many in vitro fertilization ( IVF ) centers is rapidly being replaced by closed embryo incubation systems with time-lapse imaging . Whether such systems perform comparably to manual embryology in different IVF patient population s has , however , never before been investigated . We , therefore , prospect ively compared embryo quality following closed system culture with time-lapse photography ( EmbryoScope ™ ) and st and ard embryology . We performed a two-part prospect ively r and omized study in IVF ( clinical trial # NCT92256309 ) . Part A involved 31 infertile poor prognosis patients prospect ively r and omized to EmbryoScope ™ and st and ard embryology . Part B involved embryos from 17 egg donor-recipient cycles result ing in large egg/embryo numbers , thus permitting prospect ively alternative embryo assignments to EmbryoScope ™ and st and ard embryology . We then compared pregnancy rates and embryo quality on day-3 after fertilization and embryologist time utilized per processed embryo . Results Part A revealed in poor prognosis patients no differences in day-3 embryo scores , implantation and clinical pregnancy rates between EmbryoScope ™ and st and ard embryology . The EmbryoScope ™ , however , more than doubled embryology staff time ( P < 0.0001 ) . In Part B , embryos grown in the EmbyoScope ™ demonstrated significantly poorer day-3 quality ( depending on embryo parameter between P = 0.005 and P = 0.01 ) . Suspicion that conical culture dishes of the EmbryoScope ™ ( EmbryoSlide ™ ) may be the cause was disproven when st and ard culture dishes demonstrated no outcome difference in st and ard incubation . Conclusions Though due to small patient numbers preliminary , this study raises concerns about the mostly uncontrolled introduction of closed incubation systems with time lapse imaging into routine clinical embryology . Appropriately design ed and powered prospect ively r and omized studies appear urgently needed in well-defined patient population s before the uncontrolled utilization of these instruments further exp and s . Trial registration NCT02246309 Registered September 18 , 2014 OBJECTIVE To quantify the effect on reproductive outcome of culturing and selecting embryos using a novel time-lapse monitoring system ( TMS ) . DESIGN Retrospective observational cohort study . SETTING University-affiliated private center . PATIENT(S ) Donation and autologous intracytoplasmic sperm injection ( ICSI ) cycles from ten IVF clinics using similar procedures , cultured in TMS ( n = 1,390 ) or in a st and ard incubator ( SI ; n = 5,915 ) . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Clinical pregnancy rate confirmed by ultrasound in week 7 . RESULT ( S ) A logistic regression analysis , which included all significant confounding factors , was used to evaluate the effect of culturing and selecting embryos with the use of TMS . Comparing clinical pregnancy rates per oocyte retrieval with TMS and SI treatments gave a crude effect of odds ratio [ OR ] 1.190 ( 95 % confidence interval [ CI ] 1.058 - 1.337 ) . Oocyte source , maternal age , day of transfer , and number of retrieved oocytes were identified as significant confounding factors . After accounting for confounding factors , the effect of TMS culture was OR 1.201 ( 95 % CI 1.059 - 1.363 ) . Limiting analysis to treatments with embryo transfer and including number of transferred embryos as a confounding factor likewise gave a significant effect of TMS with OR 1.157 ( 95 % CI 1.018 - 1.315 ) . CONCLUSION ( S ) Analysis of retrospective data indicated that culturing and selecting embryos by TMS significantly improved the relative probability of clinical pregnancy ( + 20.1 % per oocyte retrieval , + 15.7 % per embryo transfer ) . The elevated clinical pregnancy rate was attributed to a combination of stable culture conditions and the use of morphokinetic parameters for embryo selection OBJECTIVE To determine whether incubation in the integrated EmbryoScope time-lapse monitoring system ( TMS ) and selection supported by the use of a multivariable morphokinetic model improve reproductive outcomes in comparison with incubation in a st and ard incubator ( SI ) embryo culture and selection based exclusively on morphology . DESIGN Prospect i ve , r and omized , double-blinded , controlled study . SETTING University-affiliated private in vitro fertilization ( IVF ) clinic . PATIENT(S ) Eight hundred forty-three infertile couples undergoing intracytoplasmic sperm injection ( ICSI ) . INTERVENTION(S ) No patient intervention ; embryos cultured in SI with development evaluated only by morphology ( control group ) and embryos cultured in TMS with embryo selection was based on a multivariable model ( study group ) . MAIN OUTCOME MEASURE(S ) Rates of embryo implantation , pregnancy , ongoing pregnancy ( OPR ) , and early pregnancy loss . RESULT ( S ) Analyzing per treated cycle , the ongoing pregnancy rate was statistically significantly increased 51.4 % ( 95 % CI , 46.7 - 56.0 ) for the TMS group compared with 41.7 % ( 95 % CI , 36.9 - 46.5 ) for the SI group . For pregnancy rate , differences were not statistically significant at 61.6 % ( 95 % CI , 56.9 - 66.0 ) versus 56.3 % ( 95 % CI , 51.4 - 61.0 ) . The results per transfer were similar : statistically significant differences in ongoing pregnancy rate of 54.5 % ( 95 % CI , 49.6 - 59.2 ) versus 45.3 % ( 95 % CI , 40.3 - 50.4 ) and not statistically significant for pregnancy rate at 65.2 % ( 95 % CI , 60.6 - 69.8 ) versus 61.1 % ( 95 % CI , 56.2 - 66.1 ) . Early pregnancy loss was statistically significantly decreased for the TMS group with 16.6 % ( 95 % CI , 12.6 - 21.4 ) versus 25.8 % ( 95 % CI , 20.6 - 31.9 ) . The implantation rate was statistically significantly increased at 44.9 % ( 95 % CI , 41.4 - 48.4 ) versus 37.1 % ( 95 % CI , 33.6 - 40.7 ) . CONCLUSION ( S ) The strategy of culturing and selecting embryos in the integrated EmbryoScope time-lapse monitoring system improves reproductive outcomes . CLINICAL TRIAL REGISTRATION NUMBER NCT01549262 Purpose To assess the effects of light from an integrated optical microscope and evaluate the safety of time-lapse observations using a built-in microscope incubator . Methods We prospect ively compared the fertilization rate and embryonic morphology after intracytoplasmic sperm injection between embryos cultured with time-lapse observations every 15 min in an incubator with an integrated optical microscope and embryos with intermittent observations ( once a day ) in conventional incubators . Results No significant differences were observed in the fertilization rate ( 57.5 % vs. 57.5 % ) or the rate of excellent-good cleavage embryos ( 36.0 % vs. 36.0 % ) . Conclusions These results suggest that time-lapse observations using an incubator with an integrated optical microscope may therefore be safely utilized in clinical practice STUDY QUESTION Does culture in a closed system result in an increased number of good quality embryos ( GQE ) on Day 2 compared with culture in a conventional system ? SUMMARY ANSWER Culture in a closed system up to 2 days after microinjection results in similar embryo development and morphological quality compared with culture in a conventional incubation system . WHAT IS KNOWN ALREADY Time-lapse imaging ( TLI ) incubators are rapidly being introduced into IVF laboratories worldwide , despite the lack of large prospect i ve r and omized trials demonstrating improvement in embryo development or pregnancy rates . STUDY DESIGN , SIZE , DURATION A r and omized controlled trial including 364 patients ( 365 cycles ) was conducted between May 2010 and February 2014 . After oocyte collection , r and omization was carried out and all of a patients ' oocytes were allocated to culture in either a conventional incubator or a closed incubator system in proportion 1:2 until embryo transfer on Day 2 . A total of 1979 oocytes were injected and cultured in the closed system , and 1000 in the st and ard incubator . The primary end-point was the number of GQE in the two groups . PARTICIPANTS / MATERIAL S , SETTING S , METHODS In total , 364 patients undergoing their first IVF cycle using ICSI , where at least one oocyte was retrieved , were r and omized in a university hospital setting . Two hundred and forty patients were r and omized for culture in a closed system and 124 patients for culture in the conventional incubator system ( control group ) . Embryo assessment s and final morphological scoring before transfer and cryopreservation were carried out at the same time points for embryos cultured in the conventional incubator and in the closed system . MAIN RESULTS AND THE ROLE OF CHANCE There was no significant difference in the mean ± SD number of GQEs between groups : 2.41 ± 2.27 for the closed system group and 2.19 ± 1.82 for the control group ( P = 0.34 , difference 0.23 , 95 % confidence interval 0.69 ; -0.24 ) . No significant differences were found in the number of 4-cell embryos , implantation- , pregnancy- or ongoing pregnancy rates . A significantly higher miscarriage rate was found in the TLI group compared with the control group ( 33.3 and 10.2 % , P = 0.01 ) . LIMITATIONS , REASONS FOR CAUTION Culture media , temperature and gas levels were similar in the open and closed incubator systems , but different culture dishes were used . Culturing embryos for longer time period ( to the blastocyst stage ) may give different results . Only ICSI patients were included , which may limit the generalizability of the results . Finally , the number of GQEs on Day 2 was used as a surrogate outcome for live birth . WIDER IMPLICATION S OF THE FINDINGS The results are consistent with other , smaller r and omized trials showing no difference in embryo quality when comparing culture in a conventional incubator with that of a closed TLI incubator system BACKGROUND Time-lapse observation presents an opportunity for optimizing embryo selection based on morphological grading as well as providing novel kinetic parameters , which may further improve accurate selection of viable embryos . The objective of this retrospective study was to identify the morphokinetic parameters specific to embryos that were capable of implanting . In order to compare a large number of embryos , with minimal variation in culture conditions , we have used an automatic embryo monitoring system . METHODS Using a tri-gas IVF incubator with a built-in camera design ed to automatically acquire images at defined time points , we have simultaneously monitored up to 72 individual embryos without removing the embryos from the controlled environment . Images were acquired every 15 min in five different focal planes for at least Output:

Conclusions Currently there is insufficient evidence to support that TLI is superior to conventional methods for human embryo incubation and selection .

MS2_1shot582

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Recent dose-intensity studies of small-cell lung cancer ( SCLC ) have yielded conflicting results . We carried out a phase III r and omized trial in patients with better-prognosis SCLC ( i.e. , prognostic score of 0 - 1 ) to investigate whether doubling the dose density of ifosfamide , carboplatin , and etoposide ( ICE ) chemotherapy with filgrastim and blood-progenitor-cell support improves survival , compared with st and ard ICE chemotherapy . METHODS We studied 318 patients with pathologically proven SCLC who were r and omly assigned to receive six cycles of ICE chemotherapy with a 4-week ( st and ard arm ) or 2-week ( dose-dense arm ) interval between cycles . Patients in the dose-dense arm received filgrastim subcutaneously daily on days 4 through 14 and had autologous blood collected before cycles 2 through 6 , which was returned 24 hours after treatment . Toxicities , including hematologic toxicity and incidence of neutropenic sepsis , were monitored . Survival was calculated by the Kaplan-Meier method . All statistical tests were two-sided . RESULTS The delivered median dose intensity was 99 % ( interquartile range = 96%-100 % ) for the st and ard arm and 182 % ( interquartile range = 163%-196 % ) for the dose-dense arm . After a median follow-up of 14 months , overall response to treatment was observed in 118 ( 80 % ) of the 148 evaluable patients in the st and ard arm and in 129 ( 88 % ) of the 147 evaluable patients in the dose-dense arm , a statistically non-significant difference . Median overall survival was 13.9 months ( 95 % confidence interval [ CI ] = 12.9 to 15.8 months ) in the st and ard arm and 14.4 months ( 95 % CI = 12.7 to 16.0 ) in the dose-dense arm , and the 2-year survival was 22 % ( 95 % CI = 16 % to 29 % ) and 19 % ( 95 % CI = 14 % to 27 % ) , respectively -- neither difference being statistically significant . The median treatment free time was 286 days ( 95 % CI = 229 to 343 days ) for the st and ard arm and 367 days ( 95 % CI = 321 to 413 days ) for the dose-dense arm ( difference = 81 days ; P = .109 ) . Statistically significantly more hematologic toxicity was reported in the dose-dense arm than in the st and ard arm , but the number of cycles complicated by neutropenic sepsis was statistically significantly higher in the st and ard arm than in the dose-dense arm ( 15.3 % versus 11.6 % , respectively ; difference = 3.7 % , 95 % CI = -4.1 % to 11.5 % ; P = .03 ) . CONCLUSIONS Dose-dense ICE chemotherapy for SCLC led to shorter treatment duration and less neutropenic sepsis than did st and ard ICE but did not improve overall survival BACKGROUND The duration of , re sources required for and cost of clinical trials could be reduced if a surrogate end point was to be used in place of survival . We assessed the extent to which the objective response rate ( ORR ) is predictive of mortality , how much difference in the ORR is needed to predict an obvious survival difference and what factors could affect the association between the two parameters during the first-line treatment of extensive disease (ED)-small-cell lung cancer ( SCLC ) . METHODS We used the ORRs and median survival times ( MSTs ) from 48 phase III trials of first-line chemotherapy involving 8779 r and omised patients with ED-SCLC in a linear regression analysis . The MST difference was calculated as the difference in MST between the investigational and reference arms ; the ORR difference was similarly defined . RESULTS ORR difference between the treatment arms was modestly associated with the MST difference in the overall trials ( R(2 ) = 0.3314 ) . In contrast , the relationship was stronger among only trials in which prophylactic cranial irradiation was given to those having an objective response to the initial chemotherapy ( R(2 ) = 0.6279 ) . In this trial setting , large differences in ORR were needed to predict a survival advantage ( 1.2-day survival advantage per 2 % increase in ORR ) . CONCLUSIONS In the first-line treatment of ED-SCLC , a favourable relationship was detected between the two parameters in the selected trial setting . Large ORR differences were needed to predict a survival benefit , clearly suggesting the need for new chemotherapeutic agents PURPOSE The purpose of this study was to assess the activity and toxicity of a combined regimen of topotecan and cisplatin in " sensitive " ( s ) and " refractory " ( r ) small-cell lung cancer ( SCLC ) patients treated previously . EXPERIMENTAL DESIGN Patients with measurable SCLC and progressive disease after one first-line regimen were eligible for the study . Patients were enrolled in two separate groups : r group ( patients who failed first-line treatment <3 months from treatment discontinuation ) and s group ( patients who responded to first-line treatment and progressed > or=3 months after treatment discontinuation ) . Cisplatin was given i.v . at the dose of 60 mg/m(2 ) on day 1 , and topotecan was administered as a daily i.v . infusion at the dose of 0.75 mg/m(2 ) from day 1 to 5 , every 3 weeks . RESULTS A total of 110 eligible ( 68 s and 42 r ) patients were enrolled from 24 institutions . The main patient characteristics were as follows : median age 60 ( s ) and 55 ( r ) years , median performance status 1 for both ( s ) and ( r ) . Seventy-four percent ( s ) and 67 % ( r ) had extensive stage disease , including 22 % and 36 % , respectively , with brain metastases . A total of 398 chemotherapy courses were administered [ median 4 ( s ) and 3 ( r ) per patient ] . The most frequent and serious toxicity was myelosuppression . Grade IV neutropenia occurred in 62 % ( s ) and 49 % ( r ) of patients , with a 19 % ( s ) and 15 % ( r ) incidence of febrile neutropenia , and grade IV thrombocytopenia in 54 % ( s ) and 44 % ( r ) . Most of these toxicities occurred during the first chemotherapy course and led to topotecan dose reduction and /or delay in the following courses . Grade III-IV nonhematological toxicity was uncommon . Five deaths possibly related to toxicity occurred among s patients only . Objective responses have been documented in 20 s patients , 19 partial responses and 1 complete response , ( 29.4 % response rate ; 95 % confidence interval , 19 - 42 ) , whereas , among r patients , 10 partial responses have been observed ( 23.8 % response rate ; 95 % confidence interval , 12 - 39 ) . Median survival for s and r was 6.4 and 6.1 months , respectively . CONCLUSIONS The combination of cisplatin and topotecan , at this dose and schedule , shows activity and promising results in patients with refractory SCLC , with reversible myelosuppression being the main side effect . Additional development of this regimen , using better-tolerated schedules , is warranted in patients with refractory SCLC BACKGROUND Previous phase I-II studies have shown that the combination of paclitaxel-cisplatin-etoposide ( TEP ) is very active and well tolerated in patients with small-cell lung cancer ( SCLC ) . In order to compare the TEP combination to cisplatin etoposide ( EP ) regimen as front-line treatment in patients with SCLC , we conducted a r and omised multicenter study . PATIENTS AND METHODS One hundred thirty-three chemotherapy-naïve patients with histologically proven limited or extensive stage SCLC were r and omised to receive either paclitaxel 175 mg/m2 i.v . three-hour infusion on day 1 and cisplatin 80 mg/m2 i.v . on day 2 and etoposide 80 mg/m2 i.v . on days 2 - 4 with G-CSF support ( 5 mcg/kg s.c . days 5 - 15 ) or cisplatin 80 mg/m2 i.v . on day 1 and etoposide 120 mg/m2 i.v . on days 1 - 3 in cycles every twenty-eight days . RESULTS Due to excessive toxicity and mortality observed in the TEP arm , an early interim analysis was performed and the study was closed . Sixty-two patients received two hundred sixty-one cycles of TEP and seventy-one patients three hundred twenty-three cycles of EP The two patient groups were well balanced for age , sex , performance status , stage of disease and the presence of abnormal LDH at diagnosis . In an intention-to-treat overall analysis both regimens were equally active with a complete and partial response rate of 50 % ( 95 % confidence interval ( CI ) : 37.5%-62.4 % ) for TEP and 48 % ( 95 % ) CI : 36.2%-59.5 % ) for EP ( P = 0.8 ) . The median time to disease progression was 11 months for TEP and 9 months for EP ( P = 0.02 ) . The duration of response , one-year survival and overall survival were similar in the two arms . Similarly , in an intention-to-treat subgroup analysis of patients with limited or extensive stage disease , there was no difference in the activity between the two regimens except of a longer median time to disease progression in the extensive stage in favour of the TEP regimen , eight versus six months ( P = 0.04 ) . However , there were eight toxic deaths in the TEP arm versus none in the EP arm ( P = 0.001 ) . Moreover , the TEP regimen was associated with more severe toxicity than the EP regimen in terms of grade 4 neutropenia ( P = 0.04 ) , grade 3 - 4 thrombocytopenia ( P = 0.02 ) , febrile neutropenia ( P = 0.08 ) , grade 3 - 4 diarrhea ( P = 0.01 ) , grade 3 - 4 asthenia ( P = 0.05 ) and grade 3 neurotoxicity ( P = 0.06 ) . CONCLUSIONS In this early terminated study , the TEP regimen was significantly more toxic than the EP regimen . The TEP regimen is associated with significant toxicity and mortality , and should not be used outside of a protocol setting . For future investigations , dose and schedule modifications are necessary to reduce toxicity BACKGROUND This phase II study evaluated the efficacy and safety of the irinotecan/gemcitabine combination in patients with relapsed/refractory small-cell lung cancer ( SCLC ) . PATIENTS AND METHODS Patients with measurable tumor who had received one previous chemotherapy or chemotherapy/radiation regimen were eligible . Gemcitabine 1000 mg/m(2 ) was administered i.v . over 30 min followed immediately by irinotecan 100 mg/m(2 ) i.v . over 90 min , both on days 1 and 8 every 21 days . Patients were stratified based on response to initial treatment [ i.e. primary sensitive disease with progression > or=3 months ( group A ) , or refractory disease ( group B ) ] . RESULTS Seventy-three patients were enrolled but one never received treatment and one ineligible patient did not have SCLC . Median patient ages of the remaining patients were 61 and 63 years in groups A ( n = 35 ) and B ( n = 36 ) , respectively , with performance status of 0 or 1 in 85 % of 71 patients . Primary grade 3/4 toxic effects in groups A versus B were neutropenia ( 36 % versus 43 % ) , thrombocytopenia ( 36 % versus 26 % ) , nausea ( 12 % versus 11 % ) , vomiting ( 0 versus 11 % ) , diarrhea ( 12 % versus 9 % ) , and pulmonary ( 12 % versus 12 % ) . Two patients had fatal events including pneumonitis ( n = 1 ) and acute respiratory distress syndrome ( n = 1 ) . Responses occurred in 11 group A [ two complete responses and nine partial responses ( PRs ) ] and four group B ( all PRs ) patients , for response rates of 31 % [ 95 % confidence interval ( CI ) 17 % , 49 % ) and 11 % ( 95 % CI 3 % , 26 % ) , respectively . Median survival and progression-free survival times were 7.1 ( 95 % CI 6 , 10.5 ) versus 3.5 ( 95 % CI 3.1 , 5.7 ) months , and 3.1 ( 95 % CI 1.6 , 5.3 ) versus 1.6 ( 95 % CI 1.4 , 2.8 ) months for group A versus B. CONCLUSION The irinotecan/gemcitabine combination is active and well tolerated as second-line therapy in SCLC patients . Additional studies are warranted as second-line therapy in patients who progressed 90 days or more after first-line therapy . However , the observed efficacy results Output:

The meta- analysis of topotecan regimens ( TP ) was not reliable due to impending heterogeneity . The present meta- analysis demonstrates statistically significant OS and PFS benefits of IP over EP regimens in western and eastern patients .

MS2_1shot583

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Front of pack food labels or signpost labels are currently widely discussed as means to help consumers to make informed food choices . It is hoped that more informed food choices will result in an overall healthier diet . There is only limited evidence , as to which format of a food label is best understood by consumers , helps them best to differentiate between more or less healthy food and whether these changes in perceived healthiness result in changes of food choice . Methods In a r and omised experimental study in Hamburg/Germany 420 adult subjects were exposed to one of five experimental conditions : ( 1 ) a simple " healthy choice " tick , ( 2 ) a multiple traffic light label , ( 3 ) a monochrome Guideline Daily Amount ( GDA ) label , ( 4 ) a coloured GDA label and ( 5 ) a " no label " condition . In the first task they had to identify the healthier food items in 28 pair-wise comparisons of foods from different food groups . In the second task they were asked to select food portions from a range of foods to compose a one-day 's consumption . Differences between means were analysed using ANOVAs . Results Task I : Experimental conditions differed significantly in the number of correct decisions ( p < 0.001 ) . In the condition " no label " subjects had least correct decisions ( 20.2 ± 3.2 ) , in the traffic light condition most correct decisions were made ( 24.8 ± 2.4 ) . Task II : Envisaged daily food consumption did not differ significantly between the experimental conditions . Conclusion Different food label formats differ in the underst and ing of consumers . The current study shows , that German adults profit most from the multiple traffic light labels . Perceived healthiness of foods is influenced by this label format most often . Nevertheless , such changes in perceived healthiness are unlikely to influence food choice and consumption . Attempts to establish the informed consumer with the hope that informed choices will be healthier choices are unlikely to change consumer behaviour and will not result in the desired contribution to the prevention of obesity and diet related diseases Background : Brazil is currently debating the implementation of front-of-package labels . This study tested if Warning labels ( WLs ) improved consumer underst and ing , perceptions , and purchase intentions compared to Traffic-Light labels ( TLLs ) in 1607 Brazilian adults . Methods : In this online , r and omized controlled experiment participants saw images of 10 products and answered questions twice — once in a no-label , control condition and then again in a r and omly assigned label condition . The relative differences in responses between WLs and TLLs between control and label conditions were estimated using one-way ANOVAs or Chi-square tests . Results : Presenting WLs on products compared to TLLs helped participants : ( i ) improve their underst and ing of excess nutrient content ( 27.0 % versus 8.2 % , p < 0.001 ) ; ( ii ) improve their ability to identify the healthier product ( 24.6 % versus 3.3 % , p < 0.001 ) ; ( iii ) decrease perceptions of product healthfulness ; and ( iv ) correctly identify healthier products ( 14.0 % versus 6.9 % , p < 0.001 ) , relative to the control condition . With WLs , there was also an increase in the percentage of people : ( v ) expressing an intention to purchase the relatively healthier option ( 16.1 % versus 9.8 % , p < 0.001 ) ; and ( vi ) choosing not to buy either product ( 13.0 % versus 2.9 % , p < 0.001 ) , relative to the control condition . The participants in the WL condition had significantly more favorable opinions of the labels compared to those in the TLL group . Conclusions : WLs would be more effective , compared to the TLL , at improving consumer food choices Output:

LA countries are targeting SSB consumption through a variety of mechanisms , particularly via restrictions to availability in schools and through taxes .

MS2_1shot584

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : To investigate the lifelong health effects , costs , and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting . Study Design and Methods : Economic evaluation from a healthcare perspective with lifetime horizon alongside a nonr and omized , controlled , before-after study in the Netherl and s. Analyses were based on 1861 diabetes patients in 6 intervention and 9 control regions , representing 37 general practice s and 13 out-patient clinics . Change in the United Kingdom Prospect i ve Diabetes Study score , remaining lifetime , and costs per quality -adjusted life year gained were calculated . Probabilistic life tables were constructed using the United Kingdom Prospect i ve Diabetes Study risk engine , a vali date d diabetes model , and nonparametric bootstrapping of individual patient data . Results : Annual United Kingdom Prospect i ve Diabetes Study risk scores reduced for cardiovascular events ( hazard ratio : 0.83 and 0.98 ) and cardiovascular mortality ( hazard ratio : 0.78 and 0.88 ) for men and women , respectively . Life expectancy improved by 0.97 and 0.76 years for men and women , and quality -adjusted life years by 0.44 and 0.37 , respectively . Higher life expectancy in the intervention group increased lifelong costs by & OV0556;860 for men and & OV0556;645 for women . Initial program costs were about & OV0556;22 per patient . The incremental costs per quality -adjusted life year were & OV0556;1937 for men and & OV0556;1751 for women compared with usual care costs . There is a probability > 95 % that the collaborative is cost-effective , using a threshold of & OV0556;20,000 per quality -adjusted life year . Conclusion : Optimizing integrated and patient-centered diabetes care through a quality -improvement collaborative is cost-effective compared with usual care Background Quality improvement collaboratives ( QIC ) have proliferated internationally , but there is little empirical evidence for their effectiveness . Method We search ed Medline , Embase , CINAHL , PsycINFO and the Cochrane Library data bases from January 1995 to December 2014 . Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care ( EPOC ) minimum study design characteristics for inclusion in a review . We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 st and ards . Results Of the 220 studies meeting QIC criteria , 64 met EPOC study design st and ards for inclusion . There were 10 cluster r and omised controlled trials , 24 controlled before-after studies and 30 interrupted time series studies . QICs encompassed a broad range of clinical setting s , topics and population s ranging from neonates to the elderly . Few reports fully described QIC implementation and methods , intensity of activities , degree of site engagement and important context ual factors . By care setting , an improvement was reported for one or more of the study ’s primary effect measures in 83 % of the studies ( 32/39 ( 82 % ) hospital based , 17/20 ( 85 % ) ambulatory care , 3/4 nursing home and a sole ambulance QIC ) . Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative . Collaboratives reporting success generally addressed relatively straightforward aspects of care , had a strong evidence base and noted a clear evidence - practice gap in an accepted clinical pathway or guideline . Conclusions QICs have been adopted widely as an approach to shared learning and improvement in healthcare . Overall , the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes . These reports are encouraging , but most be interpreted cautiously since fewer than a third met established quality and reporting criteria , and publication bias is likely AIMS Improvement collaboratives consisting of various components are used throughout health care to improve quality , but no study has identified which components work best . This study tested the effectiveness of different components in addiction treatment services , hypothesizing that a combination of all components would be most effective . DESIGN An unblinded cluster-r and omized trial assigned clinics to one of four groups : interest circle calls ( group teleconferences ) , clinic-level coaching , learning sessions ( large face-to-face meetings ) and a combination of all three . Interest circle calls functioned as a minimal intervention comparison group . SETTING Out-patient addiction treatment clinics in the United States . PARTICIPANTS Two hundred and one clinics in five states . MEASUREMENTS Clinic data managers su bmi tted data on three primary outcomes : waiting-time ( mean days between first contact and first treatment ) , retention ( percentage of patients retained from first to fourth treatment session ) and annual number of new patients . State and group costs were collected for a cost-effectiveness analysis . FINDINGS Waiting-time declined significantly for three groups : coaching ( an average of 4.6 days/clinic , P = 0.001 ) , learning sessions ( 3.5 days/clinic , P = 0.012 ) and the combination ( 4.7 days/clinic , P = 0.001 ) . The coaching and combination groups increased significantly the number of new patients ( 19.5 % , P = 0.028 ; 8.9 % , P = 0.029 ; respectively ) . Interest circle calls showed no significant effect on outcomes . None of the groups improved retention significantly . The estimated cost per clinic was $ 2878 for coaching versus $ 7930 for the combination . Coaching and the combination of collaborative components were about equally effective in achieving study aims , but coaching was substantially more cost-effective . CONCLUSIONS When trying to improve the effectiveness of addiction treatment services , clinic-level coaching appears to help improve waiting-time and number of new patients while other components of improvement collaboratives ( interest circles calls and learning sessions ) do not seem to add further value OBJECTIVE To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative ( HDC ) , a national collaborative quality improvement ( QI ) program conducted in community health centers ( HCs ) . DATA SOURCES / STUDY SETTING Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study ( 1998 , 2000 , 2002 ) of the program in 17 Midwestern HCs . Data inputs for the simulation model of diabetes came from the latest clinical trials and epidemiological studies . STUDY DESIGN We conducted a societal cost-effectiveness analysis , incorporating data from QI program evaluation into a Monte Carlo simulation model of diabetes . DATA COLLECTION / EXTRACTION METHODS Data on diabetes care processes and risk factor levels were extracted from medical charts of r and omly selected patients . PRINCIPAL FINDINGS From 1998 to 2002 , multiple processes of care ( e.g. , glycosylated hemoglobin testing [ HbA1C ] [ 71 - ->92 percent ] and ACE inhibitor prescribing [ 33 - ->55 percent ] ) and risk factor levels ( e.g. , 1998 mean HbA1C 8.53 percent , mean difference 0.45 percent [ 95 percent confidence intervals -0.72 , -0.17 ] ) improved significantly . With these improvements , the HDC was estimated to reduce the lifetime incidence of blindness ( 17 - ->15 percent ) , end-stage renal disease ( 18 - ->15 percent ) , and coronary artery disease ( 28 - ->24 percent ) . The average improvement in quality -adjusted life year ( QALY ) was 0.35 and the incremental cost-effectiveness ratio was $ 33,386/QALY . CONCLUSIONS During the first 4 years of the HDC , multiple improvements in diabetes care were observed . If these improvements are maintained or enhanced over the lifetime of patients , the HDC program will be cost-effective for society based on traditionally accepted thresholds OBJECTIVE To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model . DESIGN Interventional study . Data on treatment costs were collected for infants with birth weight 501 to 1500 g for the period of January 1 , 1994 to December 31 , 1997 . Data on re sources expended by hospitals to conduct this project were collected in a survey for the period January 1 , 1995 to December 31 , 1996 . SETTING Ten self-selected neonatal intensive care units ( NICUs ) received the intervention . They formed 2 subgroups ( 6 NICUs working on infection , 4 NICUs working on chronic lung disease ) . Nine other NICUs served as a contemporaneous comparison group . PATIENTS Infants with birth weight 501 to 1500 g born at or admitted within 28 days of birth between 1994 and 1997 to the 6 study NICUs in the infection group ( N = 2993 ) and the 9 comparison NICUs ( N = 2203 ) ; infants with birth weight 501 to 1000 g at the 4 study NICUs in the chronic lung disease group ( N = 663 ) and the 9 comparison NICUs ( N = 1007 ) . INTERVENTIONS NICUs formed multidisciplinary teams which worked together to undertake a collaborative quality improvement effort between January 1995 and December 1996 . They received instruction in quality improvement , review ed performance data , identified common improvement goals , and implemented " potentially better practice s " developed through analysis of the processes of care , literature review , and site visits . MAIN OUTCOME MEASURES Treatment cost per infant is the primary economic outcome measure . In addition , the re sources spent by hospitals in undertaking the collaborative quality improvement effort were determined . RESULTS Between 1994 and 1996 , the median treatment cost per infant with birth weight 501 to 1500 g at the 6 project NICUs in the infection group decreased from $ 57 606 to $ 46 674 ( a statistical decline ) ; at the 4 chronic lung disease hospitals , for infants with birth weights 501 to 1000 g , it decreased from $ 85 959 to $ 77 250 . Treatment costs at hospitals in the control group rose over the same period . There was heterogeneity in the effects among the NICUs in both project groups . Cost savings were maintained in the year following the intervention . On average , hospitals spent $ 68 206 in re sources to undertake the collaborative quality improvement effort between 1995 and 1996 . Two thirds of these costs were incurred in the first year , with the remaining third in the second year . The average savings per hospital in patient care costs for very low birth weight infants in the infection group was $ 2.3 million in the post-intervention year ( 1996 ) . There was considerable heterogeneity in the cost savings across hospitals associated with participation in the collaborative quality improvement project . CONCLUSION Cost savings may be achieved as a result of collaborative quality improvement efforts and when they occur , they appear to be sustainable , at least in the short run . In high-cost patient population s , such as infants with very low birth weights , cost savings can quickly offset institutional expenditures for quality improvement efforts Output:

The cost savings to the healthcare setting identified in these studies outweighed the cost of the collaborative itself . Potential cost savings to the health care system in both acute and chronic conditions may be possible by applying QICs at scale . Consistent identification of costs and description of the elements applied in QICs would better inform decisions for their use and may reduce perceived barriers .

MS2_1shot585

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND It is unknown whether combined chemoradiotherapy improves overall survival in elderly patients with locally advanced non-small-cell lung cancer ( NSCLC ) . The aim of this study was to assess whether radiotherapy plus carboplatin results in longer survival than radiotherapy alone in elderly patients with NSCLC . METHODS This was a r and omised , controlled , phase 3 trial by the Japan Clinical Oncology Group ( JCOG0301 ) . Patients older than 70 years with unresectable stage III NSCLC were r and omly assigned to chemoradiotherapy ( 60 Gy plus concurrent low-dose carboplatin [ 30 mg/m(2 ) per day , 5 days a week for 20 days ] ) or radiotherapy alone , using a minimisation method with biased-coin assignment balancing on Eastern Cooperative Oncology Group ( ECOG ) performance status ( 0 vs 1 vs 2 ) , stage ( IIIA vs IIIB ) , and institution . The primary endpoint was overall survival , which was analysed for the eligible population and stratified by ECOG performance status , stage , and institution . The trial was stopped early as a result of the second planned interim analysis . This study is registered with UMIN Clinical Trials Registry , number C000000060 , and Clinical Trials.gov , number NCT00132665 . FINDINGS 200 patients were enrolled from Sept 1 , 2003 to May 27 , 2010 : 100 in the chemoradiotherapy group and 100 in the radiotherapy group . The second planned interim analysis was done 10 months after completion of patient accrual . At this time , median follow-up for censored cases was 19·4 months ( IQR 10·3 - 33·5 ) . In accordance with the prespecified stopping rule , the JCOG data and safety monitoring committee recommended early publication of this trial because the difference in overall survival favoured the chemoradiotherapy group . Median overall survival for the chemoradiotherapy and radiotherapy alone groups were 22·4 months ( 95 % CI 16·5 - 33·6 ) and 16·9 months ( 13·4 - 20·3 ) , respectively ( hazard ratio 0·68 , 95·4 % CI 0·47 - 0·98 , stratified log-rank test one-sided p value=0·0179 ) . More patients had grade 3 - 4 haematological toxic effects in the chemoradiotherapy group than in the radiotherapy alone group , including leucopenia ( 61 [ 63·5 % ] vs none ) , neutropenia ( 55 [ 57·3 % ] vs none ) , and thrombocytopenia ( 28 [ 29·2 % ] vs two [ 2·0 % ] ) . Grade 3 infection was more common with chemoradiotherapy ( 12 patients [ 12·5 % ] ) than with radiotherapy ( four patients [ 4·1 % ] ) . Incidences of grade 3 - 4 pneumonitis and late lung toxicity were similar between groups . There were seven treatment-related deaths : three of 100 patients ( 3·0 % ) in the chemoradiotherapy group and four of 100 ( 4·0 % ) in the radiotherapy group . INTERPRETATION For a select group of elderly patients with locally advanced NSCLC , combination chemoradiotherapy provides a clinical ly significant benefit over radiotherapy alone , and should be considered for this population . FUNDING Ministry of Health , Labour , and Welfare of Japan Docetaxel plus prednisone is currently the st and ard first‐line treatment in metastatic castration‐resistant prostate cancer ( mCRPC ) . The aim of this study was to assess the clinical activity and pharmacodynamic/pharmacogenetic profile of docetaxel plus prednisone in combination with metronomic cyclophosphamide in mCRPC patients This phase 1 study evaluated the safety and tolerability of antiangiogenic therapy using v and etanib and metronomic cyclophosphamide and methotrexate in metastatic breast cancer . Eligible patients had metastatic breast cancer with 0–4 prior chemotherapy regimens . All received cyclophosphamide 50 mg daily , methotrexate 2.5 mg days 1–2 weekly , and v and etanib daily in 3 dose-escalation cohorts : 100 mg ( C1 ) , 200 mg ( C2 ) , and 300 mg ( C3 ) . The primary endpoint was safety and tolerability ; secondary endpoints included response rate and evaluation of platelet-associated proteins . Twenty three patients were treated and evaluable for toxicity . Common mild toxicities included nausea , vomiting , LFTs abnormalities , fatigue , and rash . Three episodes of dose-limiting toxicity occurred in C3 . In all cohorts , 1/3 of patients required v and etanib dose reduction , and 22 % ended therapy for toxicity . Of the 20 response-evaluable patients , 10 % demonstrated partial response and 15 % stable disease ≥24 weeks . Proteomic analyses demonstrated changes in platelet content of angiogenesis regulators , including vascular endothelial growth factor and platelet factor 4 , with exposure to therapy . This regimen was tolerable at a maximum v and etanib dose of 200 mg ; modest clinical activity was observed in this heavily pretreated population . Changes in the platelet proteome may serve as pharmacodynamic markers of angiogenesis inhibition . Metronomic chemotherapy is an attractive partner with biologics and deserves further study in metastatic breast cancer Background Metronomic oral vinorelbine could be a safe option for elderly patients with advanced non small cell lung cancer ( NSCLC ) . Metronomic administration of chemotherapy leads to a cytostatic action shifting treatment target from cancer cell to tumor angiogenesis . Methods 43 chemotherapy naive elderly ( ≥70 yrs ) PS 0 - 2 patients with stage IIIB-IV NSCLC were prospect ively recruited . Median age was 80 yrs ( M/F 36/7 ) with predominantly squamous histology . PS distribution was 0 - 1(16)/2(27 ) with a median of 3 serious co-morbid illnesses . Study treatment consisted of oral vinorelbine 50 mg three times weekly ( Monday-Wednesday-Friday ) continuously until disease progression , unacceptable toxicity or patient refusal . Primary endpoints were overall response rate ( ORR ) , clinical benefit ( CB – disease response plus disease stabilization > 12 weeks ) and safety . Health-related QoL ( HRQoL ) was also assessed with FACT-L V4 scoring question naire . We conducted an exploratory time-course analysis of VEGF and thrombospondin-1 ( TSP1 ) serum levels in a subgroup of patients . Results Patients received a median of 5 ( range 1 - 21 ) cycles with a total of 272 cycles delivered . ORR was 18.6 % with 7 partial and 1 complete responses ; 17/43 experienced stable disease lasting more than 12 weeks leading to an overall CB of 58.1 % . Median time to progression was 5 ( range 2 - 21 ) and median overall survival 9 ( range 3 - 29 ) months . Treatment was well tolerated with rare serious toxicity . Regardless of severity main toxicities observed were anemia in 44 % , fatigue in 32.4 % , and diarrhoea 10.5 % . FACT-L v4 scores did not significantly vary during treatment . Baseline VEGF levels were lower and showed a rapid increase during treatment in non-responders pts only while TSP1 levels did not change . Conclusions Metronomic oral vinorelbine is safe in elderly patients with advanced NSCLC with an interesting activity mainly consisting in long-term disease stabilization coupled with an optimal patient compliance ( Eudra-CT 2010 - 018762 - 23 , AIFA OSS on 26 February 2010 ) Importance Although oral metronomic chemotherapy is often used in progressive pediatric solid malignant tumors , a literature review reveals that only small single-arm retrospective or phase 1 and 2 studies have been performed . Skepticism abounds because of the lack of level 1 evidence . Objectives To compare the effect of metronomic chemotherapy on progression-free survival ( PFS ) with that of placebo in pediatric patients with primary extracranial , nonhematopoietic solid malignant tumors that progress after at least 2 lines of chemotherapy . Design , Setting , and Participants A double-blinded , placebo-controlled r and omized clinical trial was conducted from October 1 , 2013 , through December 31 , 2015 , at the cancer center at All India Institute of Medical Sciences in children aged 5 to 18 years with primary extracranial , nonhematopoietic solid malignant tumors that progressed after at least 2 lines of chemotherapy and had no further curative options . Interventions One arm received a 4-drug oral metronomic regimen of daily celecoxib and thalidomide with alternating periods of etoposide and cyclophosphamide , whereas the other arm received placebo . Disease status was assessed at baseline , 9 weeks , 18 weeks , and 27 weeks or at clinical progression . Main Outcomes and Measures The primary end point was PFS as defined by the proportion of patients without disease progression at 6 months , and PFS duration and overall survival ( OS ) were secondary end points . Results A total of 108 of the 123 patients screened were enrolled , with 52 r and omized to the placebo group ( median age , 15 years ; 40 male [ 76.9 % ] ) and 56 to the metronomic chemotherapy group ( median age , 13 years ; 42 male [ 75.0 % ] ) . At a median follow-up of 2.9 months , 100 % of the patients had disease progression by 6 months in the placebo group vs 96.4 % in the metronomic chemotherapy group ( P = .24 ) . Median PFS and OS in the 2 groups was similar ( hazard ratio [ HR ] , 0.69 ; 95 % CI , 0.47 - 1.03 [ P = .07 ] for PFS ; and HR , 0.74 ; 95 % CI , 0.50 - 1.09 [ P = .13 ] for OS ) . In post hoc subgroup analysis , cohorts receiving more than 3 cycles ( HR for PFS , 0.46 ; 95 % CI , 0.23 - 0.93 ; P = .03 ) and those without a bone sarcoma ( ie , neither primitive neuroectodermal tumor nor osteosarcoma ) ( HR for PFS , 0.39 ; 95 % CI , 0.18 - 0.81 ; P = .01 ) appeared to benefit from metronomic chemotherapy . Conclusions and Relevance Metronomic chemotherapy does not improve 6-month PFS , compared with placebo , among pediatric patients with extracranial progressive solid malignant tumors . However , patients without bone sarcoma and those able to tolerate therapy for more than 3 cycles ( 9 weeks ) benefit . Trial Registration clinical trials.gov Identifier : NCT01858571 Prognosis of recurrent glioblastoma ( GBM ) is poor with 6-month progression-free survival ( PFS6 ) ranging from 9 to 48 % depending on the treatment regimen and use of anti-angiogenic therapies . We sought to study vorinostat ( VOR ) , a histone deacetylase inhibitor , in combination with bevacizumab ( BEV ) and daily metronomic temozolomide ( TMZ ) in a Phase I/II trial in recurrent high- grade gliomas ( HGGs ) . This was a Phase I/II open-label , single-arm study in recurrent HGG patients . Phase I primary endpoint was to determine the maximum tolerated dose ( MTD ) of VOR with BEV and daily TMZ . Phase II primary endpoint was PFS6 . Regimen was BEV 10 mg/kg iv every 2 weeks , TMZ 50 mg/m2 po daily , and VOR 200 or 400 mg po alternating 7 days on then 7 days off throughout a 28-day cycle . Phase I portion enrolled nine subjects with three receiving VOR 200 mg and 6 receiving VOR 400 mg . With no dose-limiting toxicities ( DLTs ) at 200 mg and one DLT ( thrombocytopenia , Grade 3 ) at 400 mg , the MTD was 400 mg . Phase II portion enrolled 39 GBM subjects , and PFS6 was 53.8 % ( 95 % CI 37.2–67.9 % ) . Of note , 14 subjects had received prior BEV and all had received prior 5-day TMZ . Combination therapy with VOR , BEV , and daily TMZ was well tolerated and safe . While PFS6 was not statistically improved beyond historical controls , it is important to note that this was a heavily pretreated GBM population and further consideration is warranted in a less pretreated group INTRODUCTION The goal of this study was to explore the efficacy and tolerability of metronomic chemotherapy , a novel anti-angiogenic treatment strategy , in combination with bevacizumab in patients with advanced non-small cell lung cancer ( NSCLC ) . METHODS Subjects with newly diagnosed stage IV NSCLC were treated with 4-week cycles of paclitaxel 80mg Output:

Discussion : Most of the studies did not show significantly improved overall survival or progression-free survival . Therefore , there is no definite evidence on the efficacy of single metronomic dosing and firm evidence of metronomic dosing is still missing .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Interleukin‐6 ( IL‐6 ) and C‐reactive protein ( CRP ) are elevated in prostate cancer patients , but the role of prediagnostic levels of these inflammatory mediators on prostate cancer outcomes is unclear . We undertook a large , prospect i ve case‐control study to evaluate the relation between prediagnostic levels of IL‐6 and CRP and prostate cancer incidence and mortality . We also investigated the role of the IL‐6 ( −174 G/C ) polymorphism in relation to circulating levels of IL‐6 and CRP , as well as cancer risk and mortality . We used unconditional logistic regression that adjusted for matching factors to analyze prostate cancer risk . For analyses of prostate cancer mortality , we conducted survival analyses in cases . Because of the strong link between inflammatory markers and body mass index ( BMI ) , we assessed interactions between BMI and plasma levels on prostate cancer outcomes . Neither IL‐6 nor CRP plasma levels varied significantly by IL‐6 genotype . Genotype was not associated with prostate cancer risk or survival . Though neither IL‐6 nor CRP was associated with prostate cancer incidence overall , we observed a statistically significant interaction between IL‐6 and BMI on prostate cancer incidence ( pinteraction < 0.01 ) . Increasing IL‐6 levels were positively associated with risk in healthy weight men , but inversely associated with risk in overweight men . Further , prediagnostic IL‐6 was associated with time to prostate cancer progression/death among healthy weight prostate cancer cases ( ptrend = 0.02 ) . Adjusted hazard ratios were 1.73 ( 95 % CI : 0.86 , 3.51 ) comparing the highest to lowest IL‐6 level . Our study suggests that IL‐6 may potentially be involved in the development or progression of prostate cancer . © 2008 Wiley‐Liss , Output:

This study demonstrates that CRP may have a critical prognostic value in patients with prostatic cancer

MS2_1shot587

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background . Infections are the major life-threatening complication of burn injury and occur with the greatest frequency in children . Knowledge of their occurrence and management , however , is extrapolated from studies in adults . We performed a prospect i ve study of infectious complications in burned children . Objective . To delineate epidemiology , risk factors and microbiology of infections in burned children where burn care and surgical interventions are optimal . Methods . Children hospitalized for burns were entered into prospect i ve study . Characteristics of the burn injury were assessed , and active surveillance for infections was performed . Results . Seventy patients were entered [ mean age , 42 months ; mean total body surface area ( TBSA ) , burn 15 % ] . Twenty-seven percent of patients developed 39 infections : 13 involved the burn wound ( burn wound sepsis , 6 ; graft loss , 5 ; and cellulitis , 2 ) ; 13 were catheter-associated septicemia ; 13 involved other sites ( i.e. pneumonia , 4 ; urinary tract infection , 3 ; bacteremia , 2 ; endocarditis , 1 ; myocardial abscess , 1 ; toxin-mediated syndrome , 1 ; and otitis media , 1 ) . Twenty-three infections were caused by a single organism , 9 infections by more than 1 organism and in 7 infections defined by CDC criteria no organism was recovered . Organisms causing infection were : Staphylococcus aureus , 19;C and ida albicans , 4;Pseudomonas aeruginosa , 4 ; coagulase-negative Staphylococcus , 4;Enterococcus sp. , 3;Escherichia coli , 1;Klebsiella oxytoca , 1;Serratia marcescens , 1;Streptococcus pneumoniae , 1;Streptococcus pyogenes , 1;Aspergillus fumigatus , 1 ; and C and ida parapsilosis , 1 . Burn mechanism ( flame and inhalation ) , extent ( TBSA > 30 % ) and depth ( full thickness ) were risk factors for infection ; young age and site of burn were not . Conclusion . The most common infections occurring in burn children are burn wound infections and catheter-associated septicemia . Characteristics of burn injury predict risk of infection . Children with flame and inhalation injury , TBSA burned > 30 % and full thickness burns are at high risk of infectious complications This prospect i ve , r and omized study compared protocol s of care using either AQUACEL ® Ag Hydrofiber ® ( ConvaTec , a Bristol-Myers Squibb company , Skillman , NJ ) dressing with silver ( n = 42 ) or silver sulfadiazine ( n = 42 ) for up to 21 days in the management of partial-thickness burns covering 5 % to 40 % body surface area ( BSA ) . AQUACEL ® Ag dressing was associated with less pain and anxiety during dressing changes , less burning and stinging during wear , fewer dressing changes , less nursing time , and fewer procedural medications . Silver sulfadiazine was associated with greater flexibility and ease of movement . Adverse events , including infection , were comparable between treatment groups . The AQUACEL ® Ag dressing protocol tended to have lower total treatment costs ( $ 1040 vs. $ 1180 ) and a greater rate of re-epithelialization ( 73.8 % vs 60.0 % ) , result ing in cost-effectiveness per burn healed of $ 1,409.06 for AQUACEL ® Ag dressing and $ 1,967.95 for silver sulfadiazine . A protocol of care with AQUACEL ® Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns OBJECTIVE To investigate and evaluate the clinical efficacy and safety of Acticoat with nanocrystalline silver for external use on the management of the residual wounds post-burn . METHODS One hundred and sixty-six wounds of 98 burn patients were enrolled and divided into Acticoat group and silver sulfadiazine group in the multi-center r and omized clinical trial . Acticoat was used as the treated group for those who have redness , swelling , and excessive secretion ( " heavy " exu date s ) in the wound , Acticoat was changed once a day . When there is not much secretion in the wound , or redness and swelling were not obvious , the dressings were changed once every 3 days . Silver sulfadiazine ( SD-Ag ) was used as control group , which was treated under the usual clinical routine . Healing time was observed up to 20 days . Healing percentage on the 15th day after treatment was determined . RESULTS Healing time was 12.42+/-5.40 days after the application of Acticoat . This was significantly shorter than that of control wounds . The wounds of the trial group healed nearly 3.35 days earlier than the control ones . Healing percentage at 15 days in the trial wounds was 97.37 % , which was higher than the control , but there was no significant difference between them . The bacterial clearance rate of the Acticoat group on the 6th and 12th day post-treatment was 16.67 and 26.67 % , respectively , which was significantly higher than the control . CONCLUSIONS Acticoat with nanocrystalline silver promotes the healing process of residual wounds post-burn effectively . No adverse reaction of Acticoat was found during the study Silver sulfadiazine has been used as a topical burn wound treatment for many years . Pain associated with dressing changes is a common problem in burn wounds . Aquacel Ag , a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity . The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns . This prospect i ve r and omized study was conducted in 70 patients who had partial thickness burns less than 15 % of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008 . Patients were divided into two groups : Aquacel Ag-treated group with dressing changes every 3 days ( 35 patients ) and 1 % silver sulfadiazine-treated group , with daily dressing changes ( 35 patients ) . There was no difference in demographic data including age , gender , burn percentage between groups . Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups . Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group ( 10 + /- 3 versus 13.7 + /- 4 days , P < 0.02 ) as well as pain scores at days 1 , 3 and 7 ( 4.1 + /- 2.1 , 2.1 + /- 1.8 , 0.9 + /- 1.4 versus 6.1 + /- 2.3 , 5.2 + /- 2.1 , 3.3 + /- 1.9 , respectively , P < 0.02 ) . Total cost of treatment was 52 + /- 29 US dollars for the Aquacel Ag-treated group versus 93 + /- 36 US dollars for the silver sulfadiazine-treated group . This study showed that Aquacel Ag increased time to healing , decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost . This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The very first rigorously design ed , r and omized controlled trial ( RCT ) in the history of modern medicine was published in 1948 . The study , design ed and carried out by the Streptomycin in Tuberculosis Trials Committee of the Medical Research Council , demonstrated the efficacy of streptomycin in treating pulmonary tuberculosis on top of bed rest , which was the best available treatment at that time.1 In the field of hypertension treatment and cardiovascular prevention , the history of event-based RCTs began in 1967 , when the cardiovascular benefits and risks of antihypertensive drug treatment were evaluated in the setting of the Veterans Administration Cooperative Study in Hypertension.2 In that trial , 143 patients with severe hypertension were r and omized to receive blood pressure (BP)–lowering drug treatment or matched placebo for 11 months . A major morbid or fatal event was observed in 26 of 70 patients who received placebo ( 37 % ) and in only 1 of 73 patients under active treatment ( 1 % ) . The amazing results of this l and mark trial established beyond any doubt the striking cardiovascular benefits of antihypertensive drug treatment of hypertension at a time when controversy still persisted regarding the supposedly deleterious effects of BP reduction on organ perfusion.3 Ever since , RCTs have represented a formidable tool for evaluating risks and benefits of hypertension treatment . Over the past 50 years , the remarkable progress in treatment and control of high BP , one of the most outst and ing achievements of modern medicine , has been driven by the results of many large , event-based RCTs . The influential position of RCTs in clinical and therapeutic research as opposed to real-world observational studies ( surveys , registries , and retrospective analyses of existing data bases ) originates from their high internal validity ( ie , the power to address clinical questions with a low level of internal bias ) . A list of strengths and weaknesses of RCTs and observational studies is BACKGROUND Partial-thickness burns are among the most frequently encountered types of burns , and numerous dressing material s are available for their treatment . A multicenter , open , r and omized , and parallel study was undertaken to determine the efficacy and tolerability of silver sulfadiazine ( SSD ) compared with an absorbent foam silver dressing , Mepilex Ag , on patients aged between 5 years and 65 years with deep partial-thickness thermal burn injuries ( 2.5–25 % total body surface area ) . METHODS Patients were r and omly assigned to either SSD ( n = 82 ) applied daily or a Mepilex Ag dressing ( n = 71 ) applied every 5 days to 7 days . The treatment period was up to 4 weeks . RESULTS There was no significant difference between the two treatment groups with respect to the primary end point of time to healing , which occurred in 56 ( 79 % ) of 71 patients after a median follow-up time of 15 days in the Mepilex Ag group compared with 65 ( 79 % ) of 82 patients after a median follow-up time of 16 days in the SSD group ( p = 0.74 ) . There was also no significant difference in the percentage of study burn healed . Patients in the Mepilex Ag group had 87.1 % of their study burn healed ( out of the total burn area ) compared with 85.2 % of patients in the SSD group . However , the mean total number of dressings used was significantly more in the SSD group ( 14.0 ) compared with the Mepilex Ag group ( 3.06 , p < 0.0001 ) . There was no significant difference in the time until skin graft was performed between the two study groups . CONCLUSION There was no difference in healing rates between Mepilex Ag and SSD , with both products well tolerated . The longer wear time of Mepilex Ag promotes undisturbed healing and makes it easier for patients to continue with their normal lives sooner . LEVEL OF EVIDENCE Therapeutic study , level III A new silver-coating technology was developed to prevent wound adhesion , limit nosocomial infection , control bacterial growth , and facilitate burn wound care through a silver-coated dressing material . For the purpose s of this article , Acticoat ( West aim Biomedical Inc , Fort Saskatchawan , Alberta , Canada ) silver-coated dressing was used . After in vitro and in vivo studies , a r and omized , prospect i ve clinical study was performed to assess the efficacy and ease of use of Acticoat dressing as compared with the efficacy and ease of our institution 's st and ard burn wound care . Thirty burn patients with symmetric wounds were r and omized to be treated with either 0.5 % silver nitrate solution or Acticoat silver-coated dressing . The dressing was evaluated on the basis of overall patient comfort , ease of use for the wound care provider , and level of antimicrobial effectiveness . Wound pain was rated by the patient using a visual analog scale during dressing removal , application , and 2 hours after application . Ease of use was rated by the nurse providing wound care . Antimicrobial effectiveness was evaluated by quantitative burn wound biopsies performed before and at the end of treatment . Patients found dressing removal less painful with Acticoat than with silver nitrate , but they found the pain to be comparable during application and 2 hours after application . According to the nurses , there was no statistically significant difference in the ease of use . The frequency of burn wound sepsis ( > 10(5 ) organisms per gram of tissue ) was less in Acticoat-treated wounds than in those treated with silver nitrate ( 5 vs 16 ) . Secondary bacteremias arising from infected burn wounds were also less frequent with Acticoat than with silver nitrate-treated wounds ( 1 vs 5 ) . Acticoat dressing offers a new form of dressing for the burn wound , but it requires further investigation with greater numbers of patients in a larger number of centers and in different phases of burn w Output:

There were no statistically significant differences in infection rates and surgical procedures between nanocrystalline silver , silver-impregnated hydrofiber dressing , and silver-impregnated foam dressing ; however , nanocrystalline silver was found to be the most beneficial for all the outcomes , including infection rates and surgical procedures , according to the Monte Carlo simulation method . In conclusion , current evidence from the published literature suggests that where the clinical and microbiological priority is to get in control of infection quickly it would seem prudent to use the most potent silver delivery system , which is nanocrystalline silver . Nanocrystalline silver may offer both clinical and economic benefits compared to alternative treatments in the management of patients with mixed burns that are at high risk of infection

MS2_1shot588

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Oxaliplatin and irinotecan have proven effective in the treatment of gastric cancer . We attempted to determine whether single nucleotide polymorphisms in ERCC1 , GST , TS and UGT1A1 predicted overall survival in gastric cancer patients receiving FOLFOX and /or FOLFIRI chemotherapy . Total genomic DNA was extracted from the whole blood of patients . The PCR-restriction fragment length polymorphism technique was applied in order to detect the known variant sites of ERCC1 , GST , TS and UGT1A1 . The response rate of FOLFOX ( N=75 ) was 24 % . Grade 3 - 4 neutropenia and neurotoxicity were observed at frequencies of 34.7 and 16 % , respectively . TTP and OS of first-line administration of FOLFOX ( N=35 ) were 3.1 months ( 95 % CI , 0.1 - 6.1 months ) and 13.9 months ( 95 % CI , 12.2 - 15.6 months ) , respectively . Only the GSTM1 positive genotype exhibited a significantly better time to progression ( P=0.023 ) . However , significant genotypic variation of TS , GST and ERCC1 , which was assumed to affect the activity of oxaliplatin , was not observed to affect RR , toxicity and overall survival . The response rate of FOLFIRI ( N=74 ) was 23 % . Grade 3 - 4 neutropenia and diarrhea were observed in 55.4 and 9.5 % of cases , respectively . TTP and OS of first-line administration of FOLFIRI ( N=33 ) was 4.9 months ( 95 % CI , 3.5 - 6.4 months ) and 19.0 months ( 95 % CI , 8.5 - 29.5 months ) . The low expression type ( 2R/2R , 2R/3C and 3C/3C ) of TS was associated with a high incidence of grade > or=3 neutropenia . However , significant genotypic variation of UGT1A1 , which was assumed to affect irinotecan toxicity , was not observed to affect RR , toxicity or survival . In this study , the GSTM1 positive genotype evidence d a significantly better time to progression in cases of advanced gastric cancer being treated with FOLFOX . The low expression type ( 2R/2R , 2R/3C and 3C/3C ) of TS was associated with a high incidence of grade > or=3 neutropenia in cases of advanced gastric cancer treated with FOLFIRI The discovery of pharmacogenomic markers in colorectal cancer ( CRC ) could be setting -specific . FOLFOX4 is employed in the adjuvant and metastatic setting in CRC . This prospect i ve study is aim ed to vali date in the adjuvant setting the pharmacogenomic markers of toxicity reported in the metastatic setting ( that is , GSTP1-rs947894 , and -rs1138272 ; GSTM1-null genotype ; AGXT-rs4426527 , -rs34116584 and del-74 bp ) , and to discover additional markers . CRC patients ( n=144 ) treated with adjuvant FOLFOX4 were genotyped for 57 polymorphisms in 29 genes . Grade ⩾2 neurotoxicity was associated ( false discovery rate-adjusted q-value < 0.1 ) with single-nucleotide polymorphisms in ABCC1 ( rs2074087 : odds ratio=0.43(0.22–0.86 ) ) , and ABCC2 ( rs3740066 : 2.99(1.16–7.70 ) ; rs1885301 : 3.06(1.35–6.92 ) ; rs4148396 : 4.69(1.60–13.74 ) ; rs717620 : 14.39(1.63–127.02 ) ) . hMSH6-rs3136228 was associated with grade 3–4 neutropenia ( 3.23(1.38–7.57 ) , q-value=0.0937 ) . XRCC3-rs1799794 was associated with grade 3–4 non-hematological toxicity ( 8.90(2.48–31.97 ) , q-value=0.0150 ) . The markers previously identified in metastatic CRC were not vali date d. We have identified new markers of toxicity in genes of transport and DNA repair . If vali date d in other studies , they could help to identify patients at risk of toxicity Purpose The aim of this study was to assess whether genetic polymorphisms in p53 , glutathione S-transferase P1 ( GSTP1 ) , GSTM1 , excision repair cross complementing group 1 ( ERCC1 ) and X-ray repair cross-complementing group 1 ( XRCC1 ) genes are associated with clinical outcome of gastric cancer patients treated with oxaliplatin-based adjuvant chemotherapy . Methods The genetic polymorphisms in p53 , GSTP1,GSTM1 ( null ) , ERCC1 and XRCC1 were determined in 102 gastric cancer patients treated with oxaliplatin-based adjuvant chemotherapy using polymerase chain reaction-ligation detection reaction method . Results Among the five studied polymorphisms , p53 codon 72 Pro/Pro , GSTP1 codon 105 Ile/Ile , and XRCC1 codon 399 Gln/Gln + Arg/Gln were associated with poor relapse-free survival and overall survival ( P < 0.05 ) ; and the prognostic effect was retained in the Cox multivariate analysis . Combination analysis with the three polymorphisms using the Kaplan – Meier method and Cox multivariate analysis revealed that the relapse-free and overall survivals significantly increase with the number of favorable genotypes ( P < 0.05 ) . No significant association was found between the GSTM1 ( null ) or the ERCC1 codon 118 genotypes and the clinical outcome ( P > 0.05 ) . Conclusion Testing for p53 Arg72Pro , GSTP1 Ile105Val , and XRCC1 Arg399Gln polymorphisms may allow identification of gastric cancer patients who will benefit from oxaliplatin-based adjuvant chemotherapy . Selecting specific adjuvant treatments according to the individual genetic background may represent an innovative strategy that warrants prospect i ve studies Purpose : To explore the effect of dihydropyrimidine dehydrogenase ( DPD ) single nucleotide polymorphisms ( SNP ) and haplotypes on outcome of capecitabine . Experimental Design : Germline DNA was available from 568 previously untreated patients with advanced colorectal cancer participating in the CAIRO2 trial , assigned to capecitabine , oxaliplatin , and bevacizumab ± cetuximab . The coding region of dihydropyrimidine dehydrogenase gene ( DPYD ) was sequenced in 45 cases with grade 3 or more capecitabine-related toxicity and in 100 r and omly selected controls ( cohort ) . Most discriminating ( P < 0.1 ) or frequently occurring ( > 1 % ) nonsynonymous SNPs were analyzed in all 568 patients . SNPs and haplotypes were associated with toxicity , capecitabine dose modifications , and survival . Results : A total of 29 SNPs were detected in the case – cohort analysis , of which 8 were analyzed in all 568 patients . Of the patients polymorphic for DPYD IVS14 + 1G > A , 2846A > T , and 1236G > A , 71 % ( 5 of 7 ) , 63 % ( 5 of 8) , and 50 % ( 14 of 28 ) developed grade 3 to 4 diarrhea , respectively , compared with 24 % in the overall population . All patients polymorphic for IVS14 + 1G > A developed any grade 3 to 4 toxicity , including one possibly capecitabine-related death . Because of toxicity , a mean capecitabine dose reduction of 50 % was applied in IVS14 + 1G > A and 25 % in 2846A > T variant allele carriers . Patients were categorized into six haplotype groups : one predicted for reduced ( 10 % ) , and two for increased risks ( 41 % and 33 % ) for severe diarrhea . Individual SNPs were not associated with overall survival , whereas one haplotype was associated with overall survival [ HR ( 95 % CI ) = 0.57 ( 0.35–0.95 ) ] . Conclusions : DPYD IVS14 + 1G > A and 2846A > T predict for severe toxicity to capecitabine , for which patients require dose reductions . Haplotypes assist in selecting patients at risk for toxicity to capecitabine . Clin Cancer Res ; 17(10 ) ; 3455–68 . © 2011 AACR PURPOSE The objective is to investigate whether polymorphisms with putative influence on fluorouracil/oxaliplatin activity are associated with clinical outcomes of patients with advanced colorectal cancer treated with first-line oxaliplatin , folinic acid , and fluorouracil palliative chemotherapy . MATERIAL S AND METHODS Consecutive patients were prospect ively enrolled onto medical oncology units in Central Italy . Patients were required to have cytologically/histologically confirmed metastatic disease with at least one measurable lesion . Peripheral blood sample s were used for genotyping 12 polymorphisms in thymidylate synthase , methylenetetrahydrofolate reductase , xeroderma pigmentosum group D ( XPD ) , excision repair cross complementing group 1 ( ERCC1 ) , x-ray cross complementing group 1 , x-ray cross complementing protein 3 , glutathione S-transferases ( GSTs ) genes . The primary end point of the study was to investigate the association between genotypes and progression-free survival ( PFS ) . RESULTS In 166 patients , ERCC1 - 118 T/T , XPD-751 A/C , and XPD-751 C/C genotypes were independently associated with adverse PFS . The presence of two risk genotypes ( ERCC1 - 118 T/T combined with either XPD-751 A/C or XPD-751 C/C ) occurred in 50 patients ( 31 % ) . This profiling showed an independent role for unfavorable PFS with a hazard ratio of 2.84 % and 95 % CI of 1.47 to 5.45 ( P = .002 ) . Neurotoxicity was significantly associated with GSTP1 - 105 A/G. Carriers of the GSTP1 - 105 G/G genotype were more prone to suffer from grade 3 neurotoxicity than carriers of GSTP1 - 105 A/G and GSTP1 - 105 A/A genotypes . CONCLUSION A pharmacogenetic approach may be an innovative strategy for optimizing palliative chemotherapy in patients with advanced colorectal cancer . These findings deserve confirmation in additional prospect i ve studies PURPOSE To investigate whether polymorphisms with putative influence on fluorouracil/cisplatin activity are associated with clinical outcomes of patients with advanced gastric cancer ( AGC ) . PATIENTS AND METHODS Peripheral blood sample s from 175 prospect ively enrolled AGC patients treated with fluorouracil/cisplatin palliative chemotherapy were used for genotyping 13 polymorphisms in nine genes ( TS , MTHFR , XPD , ERCC1 , XRCC1 , XRCC3 , GSTPI , GSTTI , GSTMI ) . Genotypes were correlated to response and survival . RESULTS The overall response rate was 41 % , the median progression-free survival ( PFS ) was 24 weeks ( range , 4 to 50 weeks ) , and the median overall survival ( OS ) was 39 weeks ( range , 8 to 72 + weeks ) . Chemoresistance and poor survival were significantly associated with TS 5'-UTR 3G-genotype ( 2R/3 G , 3C/3 G , 3G/3 G ) and GSTP1 105 A/A homozygous genotype . Sixty-one patients ( 35 % ) did not show any of these risk genotypes ( group 0 ) , 57 patients ( 32.5 % ) showed one of the two risk genotypes ( group 1 ) , and 57 patients ( 32.5 % ) showed both risk genotypes ( group 2 ) . Median PFS and OS in group 0 patients were 32 weeks ( range , 8 to 50 weeks ) and 49 weeks ( range , 18 to 72 + weeks ) , respectively . Group 1 and group 2 patients showed significantly worse PFS ( median , 26 weeks [ range , 6 to 44 weeks ] and 14 weeks [ range , 4 to 38 weeks ] , respectively ) and worse OS ( median , 39 weeks [ range , 10 to 58 weeks ] and 28 weeks [ range , 8 to 56 weeks ] ) , respectively , than group 0 patients . This adverse effect was retained in multivariate analysis . CONCLUSION Specific polymorphisms may influence clinical outcomes of AGC patients . Selecting palliative chemotherapy on the basis Output:

Subgroup analyses suggested that neurotoxicity was associated with GSTM1 polymorphism in the Asian population , neutropenia was associated with GSTM1 polymorphism in palliative chemotherapy and older patients ( mean age > 60 years ) , and tumor response was associated with GSTT1 polymorphism in gastric cancer and responders defined by complete and partial responses .

MS2_1shot589

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Interleukin ( IL ) 1 is a proinflammatory cytokine that has been identified as an important mediator of neurodegeneration induced by ischemia or traumatic brain injury . Accumulating evidence to date has suggested that the major cytokine contributing to neurodegeneration after head injury is IL-1beta rather than IL-1alpha ; however , there is no sufficient data regarding IL-1alpha in literature , and there may be an association between IL1A gene polymorphism and outcome after head injury . METHODS We performed a prospect i ve clinical study and included a recruited series of 71 patients who had head injury and were admitted to our neurosurgical unit . Severity of initial injury was assessed by the Glasgow Coma Scale . Outcome at 6 months after injury was assessed by means of the Glasgow Outcome Score . Interleukin 1alpha genotypes were determined from blood sample s by st and ard methods . RESULTS Of 40 patients with IL1A*2 , 18 ( 45 % ) had an unfavorable outcome ( dead , vegetative state , or severe disability ) compared with 7 ( 22.5 % ) of 31 without IL1A*2 ( P = .08 ) . CONCLUSION Our findings show that there is no genetic association between IL1A gene polymorphism and outcome after head injury . Further clinical studies should be design ed to confirm and further evaluate these findings BACKGROUND Diffuse axonal injury is a common consequence of traumatic brain injury that frequently involves the parasagittal white matter , corpus callosum , and brainstem . OBJECTIVE To examine the potential of diffusion tensor tractography in detecting diffuse axonal injury at the acute stage of injury and predicting long-term functional outcome . DESIGN Tract-derived fiber variables were analyzed to distinguish patients from control subjects and to determine their relationship to outcome . SETTING Inpatient traumatic brain injury unit . PATIENTS From 2005 to 2006 , magnetic resonance images were acquired in 12 patients approximately 7 days after injury and in 12 age- and sex-matched controls . MAIN OUTCOME MEASURES Six fiber variables of the corpus callosum , fornix , and peduncular projections were obtained . Glasgow Outcome Scale-Extended scores were assessed approximately 9 months after injury in 11 of the 12 patients . RESULTS At least 1 fiber variable of each region showed diffuse axonal injury-associated alterations . At least 1 fiber variable of the anterior body and splenium of the corpus callosum correlated significantly with the Glasgow Outcome Scale-Extended scores . The predicted outcome scores correlated significantly with actual scores in a mixed-effects model . CONCLUSION Diffusion tensor tractography-based quantitative analysis at the acute stage of injury has the potential to serve as a valuable biomarker of diffuse axonal injury and predict long-term outcome Numerous studies addressing different methods of head injury prognostication have been published . Unfortunately , these studies often incorporate different head injury prognostication models and study population s , thus making direct comparison difficult , if not impossible . Furthermore , newer artificial intelligence tools such as machine learning methods have evolved in the field of data analysis , alongside more traditional methods of analysis . This study targets the development of a set of integrated prognostication model combining different classes of outcome and prognostic factors . Method ologies such as discriminant analysis , logistic regression , decision tree , Bayesian network , and neural network were employed in the study . Several prognostication models were developed using prospect ively collected data from 513 severe closed head-injured patients admitted to the Neurocritical Unit at National Neuroscience Institute of Singapore , from April 1999 to February 2003 . The correlation between prognostic factors at admission and outcome at 6 months following injury was studied . Overfitting error , which may falsely distinguish different outcomes , was compared graphically . Tenfold cross-validation technique , which reduces overfitting error , was used to vali date outcome prediction accuracy . The overall prediction accuracy achieved ranged from 49.79 % to 81.49 % . Consistently high outcome prediction accuracy was seen with logistic regression and decision tree . Combining both logistic regression and decision tree models , a hybrid prediction model was then developed . This hybrid model would more accurately predict the 6-month post-severe head injury outcome using baseline admission parameters Background : Subjects with moderate head injury are a particular challenge for the emergency physician . They represent a heterogeneous population of subjects with large variability in injury severity , clinical course and outcome . We aim ed to determine the early predictors of outcome of subjects with moderate head injury admitted to an Emergency Department ( ED ) of a general hospital linked via telemedicine to the Regional Neurosurgical Centre . Patients and methods : We review ed , prospect ively , 12 675 subjects attending the ED of a General Hospital between 1999 and 2005 for head injury . A total of 309 cases ( 2.4 % ) with an admission Glasgow Coma Scale ( GCS ) 9–13 were identified as having moderate head injury . The main outcome measure was an unfavourable outcome at 6 months after injury . The predictive value of a model based on main entry variables was evaluated by logistic regression analysis . Findings : 64.7 % of subjects had a computed tomographic scan that was positive for intracranial injury , 16.5 % needed a neurosurgical intervention , 14.6 % had an unfavourable outcome at 6 months ( death , permanent vegetative state , permanent severe disability ) . Six variables ( basal skull fracture , subarachnoid haemorrhage , coagulopathy , subdural haematoma , modified Marshall category and GCS ) predicted an unfavourable outcome at 6 months . This combination of variables predicts the 6-month outcome with high sensitivity ( 95.6 % ) and specificity ( 86.0 % ) . Interpretation : A group of selected variables proves highly accurate in the prediction of unfavourable outcome at 6 months , when applied to subjects admitted to an ED of a General Hospital with moderate head injury OBJECTIVES To identify the demographic and clinical variables related to the duration of posttraumatic amnesia after severe closed head injury ; to evaluate the usefulness of posttraumatic amnesia duration in predicting outcome at the time of hospital discharge and at 6 months after injury . SETTING Four clinical centers located in primary care hospitals . PATIENTS Three hundred fourteen severely injured subjects aged 16 years or older who did not have trauma as a result of a penetrating injury and came out of coma before hospital discharge . INTERVENTIONS Approximately half of the subjects were administered phenytoin sodium for some period after termination of coma ; 17 % were administered dexamethasone and 41 % morphine sulfate . MAIN OUTCOME MEASURES Galveston Orientation and Amnesia Test scores defined the duration of posttraumatic amnesia . The Glasgow Outcome Scale was used to grade outcome at the time of hospital discharge and at 6 months . RESULTS Older age , low initial Glasgow Coma Scale score , nonreactive pupil(s ) , coma duration , and use of phenytoin were associated with a longer duration of posttraumatic amnesia . Poor pupillary response , time in coma , and duration of posttraumatic amnesia and use of phenytoin was predictive of the 6-month outcome . CONCLUSIONS The results support the prognostic usefulness of prospect ively measuring duration of posttraumatic amnesia after termination of coma . Pending replication , our findings suggest that posttraumatic amnesia duration may be a useful surrogate outcome measure for clinical trials involving interventions for acute head injury The early prediction of outcome after traumatic brain injury ( TBI ) is important for several purpose s , but no prognostic models have yet been developed with proven generalizability across different setting s. The objective of this study was to develop and vali date prognostic models that use information available at admission to estimate 6-month outcome after severe or moderate TBI . To this end , this study evaluated mortality and unfavorable outcome , that is , death , and vegetative or severe disability on the Glasgow Outcome Scale ( GOS ) , at 6 months post-injury . Prospect ively collected data on 2269 patients from two multi-center clinical trials were used to develop prognostic models for each outcome with logistic regression analysis . We included seven predictive characteristics-age , motor score , pupillary reactivity , hypoxia , hypotension , computed tomography classification , and traumatic subarachnoid hemorrhage . The models were vali date d internally with bootstrapping techniques . External validity was determined in prospect ively collected data from two relatively unselected surveys in Europe ( n = 796 ) and in North America ( n = 746 ) . We evaluated the discriminative ability , that is , the ability to distinguish patients with different outcomes , with the area under the receiver operating characteristic curve ( AUC ) . Further , we determined calibration , that is , agreement between predicted and observed outcome , with the Hosmer-Lemeshow goodness-of-fit test . The models discriminated well in the development population ( AUC 0.78 - 0.80 ) . External validity was even better ( AUC 0.83 - 0.89 ) . Calibration was less satisfactory , with poor external validity in the North American survey ( p < 0.001 ) . Especially , observed risks were higher than predicted for poor prognosis patients . A score chart was derived from the regression models to facilitate clinical application . Relatively simple prognostic models using baseline characteristics can accurately predict 6-month outcome in patients with severe or moderate TBI . The high discriminative ability indicates the potential of this model for classifying patients according to prognostic risk The objective of this report is to describe the design and content of the International Mission for Prognosis And Clinical Trial ( IMPACT ) data base of traumatic brain injury which contains the complete data set from most clinical trials and organized epidemiologic studies conducted over the past 20 years . This effort , funded by the U.S. National Institutes of Health , has led to the accumulation thus far of data from 9205 patients with severe and moderate brain injuries from eight r and omized placebo controlled trials and three observational studies . Data relevant to the design and analysis of pragmatic Phase III clinical trials , including pre-hospital , admission , and post-resuscitation assessment s , information on the acute management , and short- and long-term outcome were merged into a top priority data set ( TPDS ) . The major emphasis during the first phase of study is on information from time of injury to post-resuscitation and outcome at 6 months thereby providing a unique re source for prognostic analysis and for studies aim ed at optimizing the design and analysis of Phase III trials in traumatic brain injury OBJECTIVE To investigate the value of transcranial Doppler ( TCD ) ultrasonography in evaluating the outcome of severe traumatic brain injury and to correlate the TCD values with intracranial pressure ( ICP ) and cerebral perfusion pressure ( CPP ) monitoring . METHODS A prospect i ve study was conducted to evaluate the contribution of TCD ultrasonography to neurological outcome in a series of 96 severe traumatic brain injury patients . The quantitative variables of TCD ultrasonography included the mean blood flow velocity of the middle cerebral artery ( MCA ) and pulsatility index within the first 24 hours of admission . The ICP and CPP values were a lso recorded . Outcome in 6 months postinjury was evaluated using the Glasgow Outcome Scale ( GOS 4 - 5 was considered as " good " and GOS 1 - 3 as " poor " ) . RESULTS The mean blood flow velocity of the MCA was larger than 40 cm/s in 30 ( 51 % ) patients with good outcome whereas it was less than 40 cm/s in 27 ( 73 % ) patients with poor outcome ( P<0.025 ) . The mean PI in cases of good outcome ( 34 patients , 57 % ) was lower than 1.5 whereas in poor outcome ( 30 patients , 83 % ) was higher than 1.5 ( P<0.001 ) . The correlations of ICP and CPP to pulsatility index were statistically significant ( P<0.01 ) . CONCLUSIONS TCD ultrasonography is valid in predicting the patient 's outcome of 6 months and correlates significantly with ICP and CPP values when it is performed in the first 24 hours of severe traumatic brain injury The authors conducted a study to determine the value of transcranial Doppler ( TCD ) ultrasonography in evaluating the outcome of severely head injured patients and to correlate the TCD values with those obtained from intracranial pressure ( ICP ) and cerebral perfusion pressure ( CPP ) monitoring . The authors conducted a prospect i ve study of 125 patients with severe head injury ( Glascow Coma Scale scores of less than 9 ) who underwent TCD ultrasonography according to the st and ard technique of insonating the middle cerebral artery ( MCA ) and measuring the mean blood flow velocity and pulsatility index within the first 24 hours of admission . The ICP and CPP values , as well as other clinical , analytical , and neuroimaging data , were also recorded . After 6 months , outcome was evaluated using the Glasgow Outcome Scale . Moderate disability and complete recovery were considered " good " outcome ; death , vegetative state , and severe disability were considered " poor . " In 67 patients ( 54 % ) good outcome was demonstrated whereas in 58 ( 46 % ) it was poor . The mean blood flow velocity of the MCA in patients with good outcome was 44 cm/second ; in those with poor outcomes it was 36 cm/second ( p < 0.003 ) . The mean PI in cases of good outcome was 1 whereas in poor outcome was 1.56 ( p < 0.0001 ) . The correlations of ICP and CPP to PI were statistically significant ( r2 = 0.6 ; p < 0.0001 ) . When performed in the first 24 hours of severe head injury , TCD ultrasonography is valid in predicting the patient 's outcome at 6 months and correlates significantly with ICP and Output:

Strong evidence for predicting outcome at 6 months was found for the Glasgow Coma Scale ( GCS ) , GCS admission , motor score , midline shift on computed tomography scan , subdural haematoma and pulsatility index . Strong evidence of no association was found for gender and intraventricular haemorrhage . For other determinants , inconclusive or no evidence was found . GCS , GCS on admission , motor score , midline shift , subdural haematoma and pulsatility index predicted outcome 6 months after traumatic brain injury . Gender and intraventricular haemorrhage did not have predictive value

MS2_1shot590

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : Roux-en-Y reconstruction with and without jejunal pouch was compared in a r and omized controlled trial to identify the optimal reconstruction procedure in terms of quality of life . Background Data : R and omized trials comparing techniques of reconstruction after total gastrectomy have shown controversial results . Methods : One hundred and thirty-eight patients with gastric cancer were intraoperatively r and omized for Roux-en-Y reconstruction with pouch ( n = 71 ) or without pouch ( n = 67 ) after gastrectomy and stratified into curative or palliative resection . Intra- and postoperative complications were recorded . Body weight and quality of life were determined every 6 months with a follow-up of up to 12 years . Results : Both groups were comparable for age , sex , incidence of concomitant disease , and staging . There were no differences in operative time , postoperative complications , and mortality . Short- and long-term weight loss was similar in both groups . In the first postoperative year , there were no benefits of pouch reconstruction in terms of quality of life , independent of the resection status . In the third , fourth , and fifth year after surgery quality of life was significantly improved for patients with a pouch . Conclusions : Roux-en-Y pouch reconstruction after gastrectomy is simple to perform and safe . Long-term survivors benefit from pouch reconstruction . Therefore , a pouch is recommended for patients with a good prognosis BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Quality of life ( QOL ) was studied in gastric cancer patients treated on a r and omised , controlled trial comparing D1 ( level 1 ) with D3 ( levels 1 , 2 and 3 ) lymphadenectomy . A total of 221 patients were r and omly assigned to D1 ( n=110 ) and D3 ( n=111 ) surgery . Quality -of-life assessment s included functional outcomes ( a 14-item survey about treatment-specific symptoms ) and health perception ( Spitzer QOL Index ) was performed before and after surgery at disease-free status . Patients suffered from irrelative events such as loss of partners was excluded thereafter . Main analyses were done by intention-to-treat . Thus , 214 D1 ( 106/110=96.4 % ) and D3 ( 108/111=97.3 % ) R0 patients were assessed . Longitudinal analysis showed that functional outcomes decreased at 6 months after surgery and increased over time thereafter , while health perceptions increased over time in general . On the basis of linear mixed model analyses , patients having total gastrectomy , advanced cancer and hemipancreaticosplenectomy , but not complications had poorer QOL than those without . D1 and D3 patients showed no significant difference in QOL . The results suggest that changes of QOL were largely due to scope of gastric resection , disease status and distal pancreaticosplenectomy , rather than the extent of lymph node dissection . This indicates that nodal dissection can be performed for a potentially curable gastric cancer This is an interim report of a r and omized clinical trial on esophagojeju-nostomy ( EJ ) versus Hunt-Lawrence-Rodino ( HLR ) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment . The r and omized trial preceded a pilot study comparing the Longmire-Gütgemann interposition and the HLR . The pilot study included 7 patients , the r and omized trial 38 patients ( 60 planned ) . The main outcome variables in the pilot study were food resorption , caloric intake , and body weight . Survival probability and general well-being ( quality of life ) were measured in the r and omized trial . A score was composed of disease-specific and socio-personal variables with well-being ranging from 0 ( worst ) to 14 ( best ) points . Concerning food resorption in the pilot study , no relevant advantage of the duodenal passage was found . The main postoperative disorder was insufficient food intake . Despite a radical operation , a hospital mortality rate of 16 % , and a complication rate of 37 % , gastric cancer still has a poor prognosis . In the r and omized trial only 15 ( 39 % ) of 38 patients were alive 1 year after operation , but the survival probability was higher ( 58 % ) after HLR than after EJ ( 24 % ) ( p<0.05 ) . Hunger and appetite were strongly reduced during the first 6 months after operation . Food intake was less than half of the preoperative values , which was reflected by an average decrease in body weight of 7 kg . Patients dying within the first year after total gastrectomy suffered an irreversible loss of quality of life ( scoring 7 points ) . They had no objective benefit from the operation . Patients surviving this period regained quality of life and exceeded preoperative values , especially after HLR.We conclude that HLR-operated patients who have a chance of surviving for at least 1 year benefit from total gastrectomy in regard to quality of life . RésuméCet article est consacré au bilan provisoire d'une étude clinique r and omisée de l'oesophago-jéjunostomie ( EJ ) par rapport à l'opération de Hunt-Lawrence-Rodino ( HLR ) comme technique de reconstruction après gastrectomie totale et lymphadénectomie systématique pour cancer de l'estomac . Le bilan a été établi à partir d'une étude pilote comparant l'interposition Longmire-Gütgemann et la HLR . Cette première étude a porté sur 7 patients et le étude r and omisée sur 38 patients ( 60 sont prévues ) . Dans l'étude pilote la réabsorption intestinale , le poids et l'absorption calorique furent les variables essentielles pour mesurer l'avenir des malades . Dans le étude r and omisée la probabilité de survie et la qualité de la vie ont été ajoutées . L'état général a été représenté par un score comprenant des variables spécifiques de la maladie et socio-personnelles allant de 0 ( très mal ) à 14 ( très bien ) points . Dans l'étude pilote le passage duodénal n'a pas montré d'avantage concernant la réabsorption intestinale . Le malaise post-opératoire essentiel a été l'insuffisance de l'absorption calorique . L'opération radicale a une mortalité hospitalière de 16 % et comprend un taux de complication de 37 % . Le cancer de l'estomac est de prognostic peu favorable . Seuls 15 ( 39 % ) des 38 patients ont survécu la première année dans le étude r and omisée mais la probabilité de survie après HLR ( 58 % ) dépasse celle après EJ ( 24 % ) ( p<0.05 ) . La f aim et l'appétit ont été sévèrement réduits pendant les 6 premiers mois post-opératoires . Comparée à la situation pré-opératoire , la quantitié de nourriture a diminué d'au moins 50 % ce qui correspond à une perte de poids de 7 kilos en moyenne . Les malades qui ne survivent pas la première année subissent une perte importante et irréversible de leur qualité de vie . Ceci nous amène à dire qu'ils ne profitent pas de l'intervention chirurgicale contraitement aux autres qui regagnent une qualité de vie égale ou même supérieure aux valeurs pré-opératoires . Au total nous pouvons affirmer que ce sont essentiellement les patients opérés qui ont subi une HLR qui survivent un an ou plus et qui tirent profit de la gastrectomie totale . ResumenEste es un informe provisional de un ensayo clínico aleatorizado para comparar la esofagoyeyunostomía ( EY ) con la bolsa de Hunt-Lawrence-Rodino ( HLR ) como técnicas de reconstrucción gástrica después de gastrectomía total con linfadenectomía sistemática como tratamiento del cáncer gástrico . El ensayo aleatorizado fue precedido de un estudio piloto para comparar el procedimiento de interposición de Longmire-Gütgemann con la HLR . El estudio piloto incluyó 7 pacientes y el ensayo aleatorizado 38 pacientes ( 60 fueron planeados ) . Las principales variables analizadas en el estudio piloto fueron la resorción de alimentos , la ingesta calórica , y el peso corporal . En el ensayo aleatorizado fueron analizadas , además , la probabilidad de supervivencia y el estado de bienestar general ( calidad de la vida ) . Se construyó un puntaje a partir de variables específicas de la enfermedad y sociopersonales para calificar el estado de bienestar general ( calidad de la vida ) entre 0 ( peor ) y 14 (óptimo).En el estudio piloto el paso a través del duodeno no demostró ventaja significativa en cuanto a la resorción intestinal . La principal alteración postoperatoria fue la ingesta alimenticia insuficiente . A pesar de una operación radical , una mortalidad de 16 % , y una tasa de complicaciones de 37 % , el cáncer gástrico mantiene un pronóstico poco favorable . En el ensayo aleatorizado sólo 15 ( 39 % ) de 38 pacientes sobrevivían 1 año después de la operación , con una probabilidad de supervivencia mayor ( 58 % ) después de la HLR que después de la EY ( 24 % ) ( p<0.05 ) . El hambre y el apetito aparecieron notoriamente disminuidos durante el primer semestre después de la operación . La ingesta de alimento fue menos de la mitad del valor preoperatorio , lo cual se manifestó en una disminución del peso corporal de 7 kg en promedio . Los pacientes que murieron en el curso del primer año después de la gastrectomía total exhibieron una disminución importante e irreversible de la calidad de la vida ( cerca de 7 puntos ) y no demostraron beneficio objetivo de la operación , en comparación con los que sobrevivieron tal período , quienes recuperaron una buena calidad de la vida con valores iguales o superiores a los preoperatorios , especialmente después de HLR.Nuestra conclusión es que los pacientes sometidos al procedimiento HLR que sobreviven por lo menos 1 año , se benefician de la gastrectomía total en lo relativo a la calidad de la vida Objective : During recent years considerable interest has been focused on quality of life as an additional therapeutic outcome measure in the surgical treatment of gastric carcinoma . However , the long term consequences of gastrectomy and the impact on quality of life of different reconstructive techniques are still a matter of controversy . To broaden the criteria for choice of treatment , we conducted a prospect i ve r and omized clinical trial to determine the impact of various gastrectomy procedures on quality of life during a 5-yr follow-up period . Methods : Consecutive patients ( n= 64 ) eligible for curative gastric cancer surgery were r and omized to have either total ( n= 31 ) or subtotal ( n= 13 ) gastrectomy or a jejunal S-shaped pouch ( n= 20 ) as a gastric substitute after total gastrectomy . Assessment s of quality of life were made on seven occasions during a 5-yr period : within 1 wk before surgery , 3 and 12 months after the surgical intervention , and then once/yr . All patients were interviewed by one of two psychiatrists , who rated their symptoms and introduced st and ardized self-report question naires covering both general and specific aspects of life . The raters were blinded for the patients ’ group affiliations . Results : Survival rates were similar in all treatment groups . Patients who had a total gastrectomy continued to suffer from alimentary symptoms , especially indigestion and diarrhea , during the entire follow-up period . However , patients who underwent subtotal gastrectomy had a significantly better outcome already during the first postoperative yr . Patients given a gastric substitute after gastrectomy improved with the passage of time and had an even better outcome in the long run . Conclusions : To optimize the rehabilitation after gastrectomy , patients ’ quality of life must be taken into consideration . When subtotal gastrectomy is clinical ly feasible , this procedure has advantages in the early postoperative period . However , a pouch reconstruction after total gastrectomy should be considered in patients having a favorable tumor status suggesting a fair chance of Output:

Conclusions Most RCTs of gastric cancer surgery do not include measures of QOL and those that do suffer from important limitations . RCTs would be more useful to surgeons and patients if authors measured PROs and utilized existing approaches to present the results of PROs in ways that provide an intuitive sense of the magnitude of effects

MS2_1shot591

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To quantify the inter-fraction shape variation of the mesorectum for rectal cancer patients treated with 5 x 5 Gy in supine position and compare it to variation in prone position . METHODS AND MATERIAL S For 28 patients a planning CT ( pCT ) and five daily cone-beam-CT ( CBCT ) scans were acquired in supine position . The mesorectal part of the CTV ( MesoRect ) was delineated on all scans . The shape variation was quantified by the distance between the pCT- and the CBCT delineations and stored in surface maps after online setup correction . Data were analyzed for male and female patients separately and compared to prone data . RESULTS A large range of systematic , 1 - 8 mm ( 1SD ) , and r and om , 1 - 5 mm , shape variation was found , comparable to prone patients . R and om-shape variation was comparable for male and female patients , while systematic variation was 3 mm larger for female patients . CONCLUSIONS Shape variation of the MesoRect is substantial , heterogeneous and different between male and female patients . Differences between supine and prone orientation , however , are small . Clinical margins should be differentiated in position along the cranio-caudal axis , in anterior-posterior direction and for gender . Margins should also be increased , even when online setup correction is used . Due to the small margin differences between prone and supine treatments , the setup choice should be determined on dose to the organs at risk PURPOSE To develop a Radiation Therapy Oncology Group ( RTOG ) atlas of the elective clinical target volume ( CTV ) definitions to be used for planning pelvic intensity-modulated radiotherapy ( IMRT ) for anal and rectal cancers . METHODS AND MATERIAL S The Gastrointestinal Committee of the RTOG established a task group ( the nine physician co- authors ) to develop this atlas . They responded to a question naire concerning three elective CTVs ( CTVA : internal iliac , presacral , and perirectal nodal regions for both anal and rectal case planning ; CTVB : external iliac nodal region for anal case planning and for selected rectal cases ; CTVC : inguinal nodal region for anal case planning and for select rectal cases ) , and to outline these areas on individual computed tomographic images . The imaging files were shared via the Advanced Technology Consortium . A program developed by one of the co- authors ( I.E.N. ) used binomial maximum-likelihood estimates to generate a 95 % group consensus contour . The computer-estimated consensus contours were then review ed by the group and modified to provide a final contouring consensus atlas . RESULTS The panel achieved consensus CTV definitions to be used as guidelines for the adjuvant therapy of rectal cancer and definitive therapy for anal cancer . The most important difference from similar atlases for gynecologic or genitourinary cancer is mesorectal coverage . Detailed target volume contouring guidelines and images are discussed . CONCLUSION This report serves as a template for the definition of the elective CTVs to be used in IMRT planning for anal and rectal cancers , as part of prospect i ve RTOG trials Summary Background Preoperative or postoperative radiotherapy reduces the risk of local recurrence in patients with operable rectal cancer . However , improvements in surgery and histopathological assessment mean that the role of radiotherapy needs to be reassessed . We compared short-course preoperative radiotherapy versus initial surgery with selective postoperative chemoradiotherapy . Methods We undertook a r and omised trial in 80 centres in four countries . 1350 patients with operable adenocarcinoma of the rectum were r and omly assigned , by a minimisation procedure , to short-course preoperative radiotherapy ( 25 Gy in five fractions ; n=674 ) or to initial surgery with selective postoperative chemoradiotherapy ( 45 Gy in 25 fractions with concurrent 5-fluorouracil ) restricted to patients with involvement of the circumferential resection margin ( n=676 ) . The primary outcome measure was local recurrence . Analysis was by intention to treat . This study is registered , number IS RCT N 28785842 . Findings At the time of analysis , which included all participants , 330 patients had died ( 157 preoperative radiotherapy group vs 173 selective postoperative chemoradiotherapy ) , and median follow-up of surviving patients was 4 years . 99 patients had developed local recurrence ( 27 preoperative radiotherapy vs 72 selective postoperative chemoradiotherapy ) . We noted a reduction of 61 % in the relative risk of local recurrence for patients receiving preoperative radiotherapy ( hazard ratio [ HR ] 0·39 , 95 % CI 0·27–0·58 , p<0·0001 ) , and an absolute difference at 3 years of 6·2 % ( 95 % CI 5·3–7·1 ) ( 4·4 % preoperative radiotherapy vs 10·6 % selective postoperative chemoradiotherapy ) . We recorded a relative improvement in disease-free survival of 24 % for patients receiving preoperative radiotherapy ( HR 0·76 , 95 % CI 0·62–0·94 , p=0·013 ) , and an absolute difference at 3 years of 6·0 % ( 95 % CI 5·3–6·8 ) ( 77·5 % vs 71·5 % ) . Overall survival did not differ between the groups ( HR 0·91 , 95 % CI 0·73–1·13 , p=0·40 ) . Interpretation Taken with results from other r and omised trials , our findings provide convincing and consistent evidence that short-course preoperative radiotherapy is an effective treatment for patients with operable rectal cancer . Funding Medical Research Council ( UK ) and the National Cancer Institute of Canada BACKGROUND Postoperative chemoradiotherapy is the recommended st and ard therapy for patients with locally advanced rectal cancer . In recent years , encouraging results with preoperative radiotherapy have been reported . We compared preoperative chemoradiotherapy with postoperative chemoradiotherapy for locally advanced rectal cancer . METHODS We r and omly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative chemoradiotherapy . The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day , five days per week , and fluorouracil , given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy . Surgery was performed six weeks after the completion of chemoradiotherapy . One month after surgery , four five-day cycles of fluorouracil ( 500 mg per square meter per day ) were given . Chemoradiotherapy was identical in the postoperative-treatment group , except for the delivery of a boost of 540 cGy . The primary end point was overall survival . RESULTS Four hundred twenty-one patients were r and omly assigned to receive preoperative chemoradiotherapy and 402 patients to receive postoperative chemoradiotherapy . The overall five-year survival rates were 76 percent and 74 percent , respectively ( P=0.80 ) . The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative chemoradiotherapy and 13 percent in the postoperative-treatment group ( P=0.006 ) . Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group , as compared with 40 percent of the patients in the postoperative-treatment group ( P=0.001 ) ; the corresponding rates of long-term toxic effects were 14 percent and 24 percent , respectively ( P=0.01 ) . CONCLUSIONS Preoperative chemoradiotherapy , as compared with postoperative chemoradiotherapy , improved local control and was associated with reduced toxicity but did not improve overall survival PURPOSE To determine the reduction of prostate motion during a typical radiotherapy ( RT ) fraction from a bowel regimen comprising an antiflatulent diet and daily milk of magnesia . METHODS AND MATERIAL S Forty-two patients with T1c-T2c prostate cancer voided the bladder and rectum before three cinematic magnetic resonance imaging scans obtained every 9 s for 9 min in a vacuum immobilization device . The MRIs were at baseline without bowel regimen ( MRI-BL ) , before CT planning with bowel regimen ( MRI-CT ) , and before a r and omly assigned RT fraction ( 1 - 42 ) with bowel regimen ( MRI-RT ) . A single observer tracked displacement of the posterior midpoint ( PM ) of the prostate . The primary endpoints were comparisons of the proportion of time that the PM was displaced > 3 mm ( PTPM3 ) from its initial position , and the secondary endpoints were comparisons of the reduction of initial rectal area , with and without the bowel regimen . RESULTS The mean rectal area was : 13.5 cm(2 ) at MRI-BL , 12.7 cm(2 ) at MRI-CT , and 12.3 cm(2 ) at MRI-RT ( MRI-BL vs. MRI-CT , p = 0.11 ; MRI-BL vs. MRI-CT , p = 0.07 ) . Moving rectal gas alone ( 56 % ) and moving gas and stool ( 18 % ) caused 74 % of intrafraction prostate motion . The PTPM3 was 11.3 % at MRI-BL , 4.8 % at MRI-CT , and 12.0 % at MRI-RT ( MRI-BL vs. MRI-CT , p = 0.12 ; MRI-BL vs. MRI-RT , p = 0.89 ) . CONCLUSION For subjects voiding their rectum before imaging , an antiflatulent diet and milk of magnesia laxative did not significantly reduce initial rectal area or intrafraction prostate motion Background and Purpose : In locally advanced rectal cancer , neoadjuvant radiochemotherapy is indicated . To improve target volume definition for radiotherapy planning , the potential of implanted gold markers in the tumor region was evaluated . Patients and Methods : In nine consecutive patients , two to three gold markers were implanted in the tumor region during rigid rectoscopy . Computed tomography scans were performed during treatment planning . All electronic portal imaging devices ( EPIDs ) recorded during treatment series were analyzed . All patients underwent complete tumor resection with meticulous histopathologic examination . Results : The gold markers could easily be implanted into the mesorectal tissue at the caudal tumor border without any complications . They were helpful in identifying the inferior border of the planning target volume in order to spare normal tissue ( in particular anal structures ) . No significant shift of the markers was found during the course of therapy . Marker matching of the EPIDs did not improve patient positioning in comparison to bone structure matching . The former position of at least one marker could be identified in all patients during histopathologic examination . Conclusion : The use of gold marker enables a more precise definition of the target volume for radiotherapy in patients with rectal cancer . This could eventually allow a better protection of anal structures of patients with a tumor localization ≥ 5 cm cranial of the anal sphincter . The implantation of the gold markers improved communication between the surgeon , the radiooncologist and the pathologist result ing in intensified exchange of relevant informations . Hintergrund und Ziel : Bei Patienten mit fortgeschrittenem Rektumkarzinom ist eine neoadjuvante Radiochemotherapie indiziert . Um die Definition des Zielvolumens zu verbessern , wurde das Potential von implantierten Goldmarkern in der Tumorregion untersucht . Patienten und Method ik : Bei neun konsekutiven Patienten wurden während der prätherapeutischen starren Rektoskopie zwei bis drei Goldmarker in die Tumorregion implantiert . Für die Bestrahlungsplanung wurden computertomographische Bilder aufgenommen . Alle während der Bestrahlung aufgenommenen Portal-Image-Bilder wurden analysiert . Alle Patienten erhielten eine komplette Tumorresektion mit anschließender histopathologischer Untersuchung . Ergebnisse : Die Goldmarker konnten einfach und komplikationslos in das mesorektale Gewebe am kaudalen Tumorr and gelegt werden . Sie waren hilfreich bei der Identifikation des unteren Tumorr and s während der Bestrahlungsplanung , um Normalgewebe ( insbesondere die analen Strukturen ) bei der Bestrahlung schonen zu können . Es f and sich keine signifikante Verschiebung der absoluten Markerpositionen während der Bestrahlung . Eine Korrektur der Lagerung der Patienten nach Markern ergab keinen Vorteil gegenüber der Korrektur mit knöchernen L and marken . Die ehemalige Position von mindestens einem Marker konnte bei jedem Patienten in der histopathologischen Untersuchung bestimmt werden . Schlussfolgerung : Die Verwendung von Goldmarkern bei Patienten mit Rektumkarzinom ermöglicht eine präzisere Definition der Zielvolumens für die Bestrahlungsplanung . Dadurch könnten evtl . anale Strukturen bei einer Tumorlage von ≥ 5 cm kranial des Analsphinkters geschont werden . Die Implantation von Goldmarkern verbessert die Kommunikation zwischen Chirurgen , Radioonkologen und Pathologen , was in einem intensivierten Austausch relevanter Informationen result iert Purpose To compare target dose distribution , comformality , normal tissue avoidance , and irradiated body volume ( IBV ) in 3DCRT using classic anatomical l and marks ( c3DCRT ) , 3DCRT fitting the PTV ( f3DCRT ) , and intensity-modulated radiation therapy ( IMRT ) in patients with locally advanced rectal cancer ( Output:

There was a strong relationship between rectal filling and mesorectal motion . Current margin recipes may not apply to deformable structures .

MS2_1shot592

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Isepamicin is a new aminoglycoside antibiotic which possesses greater stability to aminoglycoside-inactivating enzymes compared with other available aminoglycosides . In this prospect i ve , r and omised , open trial , the safety and efficacy of intravenous administration of isepamicin was compared with that of intravenous amikacin in seriously ill adults with nosocomial pneumonia or septicaemia . Each study aminoglycoside was administered concurrently with ceftazidime or imipenem . Patients were r and omised to receive isepamicin 15 mg/kg once daily , isepamicin 7.5 mg/kg twice daily or amikacin 7.5 mg/kg twice daily . For patients with nosocomial pneumonia , the proportions of patients in the intent-to-treat population ( n = 130 ) who were clinical ly cured at the end of treatment were similar in each treatment group : 18/44 ( 41 % ) isepamicin once daily ; 19/45 ( 42 % ) isepamicin twice daily ; and 17/41 ( 42 % ) amikacin . Corresponding results for the efficacy population ( n = 58 ) were : 12/20 ( 60 % ) isepamicin once daily ; 14/21 ( 67 % ) isepamicin twice daily ; 9/17 ( 53 % ) amikacin . In patients with septicaemia , clinical cure was achieved in 8/10 ( 80 % ) patients treated with isepamicin once daily , compared with 8/13 ( 62 % ) patients who received isepamicin twice daily , and 7/12 ( 58 % ) patients treated with amikacin . For both diagnoses , there were no statistically significant differences between the treatment groups in clinical cure rate . The most commonly isolated target pathogen was Pseudomonas aeruginosa . For both nosocomial pneumonia and septicaemia , the proportion of patients in the intent-to-treat population whose pretreatment valid target pathogens were eliminated was similar in each treatment group . In total , 51 patients ( 30 % ) died during study , mostly due to disease progression or complications , or concurrent illness . All three treatment regimens were well tolerated . The proportion of patients experiencing at least one adverse event was 11 % , 25 % and 9 % for isepamicin once daily , isepamicin twice daily and amikacin , respectively . The incidence of ototoxicity and nephrotoxicity was relatively low in both treatment groups We evaluated the antimicrobial activity of fosfomycin against a r and omly selected sample of 30 Klebsiella pneumoniae , 30 Pseudomonas aeruginosa , and 30 Acinetobacter baumannii multidrug-resistant , clinical isolates from patients in a general tertiary care hospital in Athens , Greece . St and ard laboratory methods were used for susceptibility testing to commonly used antibiotics and the detection of extended-spectrum-β-lactamase ( ESBL ) and metallo-β-lactamase ( MBL ) production . The minimum inhibitory concentration ( MIC ) of fosfomycin for each isolate was determined by the agar dilution method . All K. pneumoniae isolates were both ESBL and MBL producers ; all P. aeruginosa isolates were ESBL producers . The K. pneumoniae strains had fosfomycin MICs distributed across a range of 8 - 64 μg/ml ; MIC50 was 16 μg/ml and MIC90 32 μg/ml . The fosfomycin MICs of the P. aeruginosa strains had a distribution across a range of 4 to over 512 μg/ml ; MIC50 was 32 μg/ml and MIC90 128 μg/ml . The fosfomycin MICs of the A. baumannii strains had a distribution across a range of 64 to over 512 μg/ml ; MIC50 was 256 μg/ml and MIC90 more than 512 μg/ml . Although st and ardized fosfomycin MIC interpretative breakpoints for the species studied are lacking , the findings of our study support the idea that fosfomycin may be further investigated as one among a decreasing list of therapeutic options for the treatment of infections due to multidrug-resistant strains of , primarily , K. pneumoniae and , secondly , P. aeruginosa In a prospect i ve multicentre open trial , hospitalised adult patients with acute lower respiratory tract infections , mainly pneumonia or bronchitis , were r and omised to receive either isepamicin 8 or 15 mg/kg once daily depending on the severity of the infection or amikacin 7.5 mg/kg twice daily . Patients with infections known to be caused by Pseudomonas aeruginosa were to be given concomitant treatment with ceftazidime . In the intent-to-treat population , i.e. patients who received at least one dose r and omised treatment , a clinical cure or improvement at the end of treatment was seen in 112/125 ( 90 % ) isepamicin patients and 55/60 ( 92 % ) amikacin patients . The corresponding rates for patients with a primary diagnosis of pneumonia were 45/52 ( 87 % ) and 25/28 ( 89 % ) . Cure/improvement rates for patients with P. aeruginosa as the causative pathogen ( 34 of whom also received ceftazidime ) were 28/30 ( 93 % ) and 16/18 ( 89 % ) , respectively . In the efficacy population ( patients who had a valid pretreatment culture and who met other evaluability criteria ) , total elimination ( documented or presumed if infection had resolved ) of target pathogens occurred in 54/63 ( 86 % ) of isepamicin patients and 25/30 ( 83 % ) of amikacin patients . P. aeruginosa , Escherichia coli , Klebsiella pneumoniae and Staphylococcus aureus were commonly isolated pathogens . Treatment-related adverse were mainly mild or moderate in severity and occurred in 10 % of isepamicin patients and 13 % of amikacin patients . Four patients ( 3 isepamicin and 1 amikacin ) discontinued treatment because of severe adverse events and a further isepamicin patient withdrew because of a mild adverse event . Nephrotoxicity and ototoxicity occurred infrequently Intensive care unit (ICU)-acquired infections as a result of multidrug-resistant Gram-negative pathogens remain a serious problem in critically ill patients . Adult ICU patients who received intravenous fosfomycin were prospect ively examined to assess its safety and effectiveness as an adjunct to the antimicrobial therapy of life-threatening infections caused by carbapenem-resistant Klebsiella pneumoniae . Fosfomycin was administered intravenously in 11 patients for treatment of hospital-acquired infections caused by carbapenem-resistant K. pneumoniae . Fosfomycin ( 2 - 4 g every 6 h ) was administered in combination with other antibiotics . The mean + /- SD duration of treatment was 14 + /- 5.6 days . All patients had good bacteriological and clinical outcome of infection . All-cause hospital mortality was two out of 11 ( 18.2 % ) patients . No patient experienced adverse events related to the administration of fosfomycin . Intravenous fosfomycin may be a beneficial and safe adjunctive treatment in the management of life-threatening ICU-acquired infections caused by carbapenem-resistant K. pneumoniae ABSTRACT Directed evolution by r and om PCR mutagenesis of the gene for the aminoglycoside 2″-IIa phosphotransferase generated R92H/D268N and N196D/D268N mutant enzymes , result ing in elevated levels of resistance to amikacin and isepamicin but not to other aminoglycoside antibiotics . Increases in the activities of the mutant phosphotransferases for isepamicin are the result of decreases in Km values , while improved catalytic efficiency for amikacin is the result of both a decrease in Km values and an increase in turnover of the antibiotic . Enzymes with R92H , D268N , and D268N single amino acid substitutions did not result in elevated MICs for aminoglycosides Two hundred and three patients with skin and skin structure infections were treated with isepamicin once daily or amikacin twice daily in an open , r and omised , comparative multicentre trial . Patients were r and omised to treatment with isepamicin or amikacin in a 2:1 ratio . Severe infections ( 63 patients ) were treated with isepamicin 15 mg/kg once daily ( n = 15 ) or amikacin 7.5 mg/kg twice daily ( n - 18 ) , less severe infections ( 140 patients ) with isepamicin 8 mg/kg once daily ( n = 93 ) or amikacin 7.5 mg/kg twice daily ( n = 47 ) . The overall clinical response rate at the end of treatment was excellent in all treatment groups ( 94 - 96 % cured or improved ) with no significant differences between isepamicin and amikacin in patients with either server or less severe infections . The most commonly isolated target pathogens were Pseudomonas aeruginosa , Escherichia coli , Proteus mirabilis and Staphylococcus aureus . Overall , in patients who had a valid target pathogen isolated prior to treatment and who met other evaluability criteria , bacteriological eradication was achieved in over 90 % of patients ; amikacin patients with severe infections had a somewhat lower eradication rate ( 82 % ) . Over all infections , 4/110 ( 4 % ) patients in the isepamicin group and 5/54 ( 9 % ) patients in the amikacin had organisms which persisted . Adverse events were reported in 12 % of patients in the isepamicin group and 6 % in the amikacin group . The most frequently reported adverse event in the isepamicin group as headache . Two patients ( one in each treatment group ) , both of whom experienced skin rashes , were withdrawn . Potentially clinical ly significant changes in serum creatinine occurred in two patients , who received isepamicin and one who received amikacin ( who was withdrawn from the study ) . Ototoxicity was rare , occurring in one patient treated with isepamicin In this study we compared the efficacy and safety of isepamicin versus amikacin at a dose of 7.5 mg/kg i.v . q12h for 10 - 14 days in children with pyelonephritis . Sixteen children were enrolled in the study ; ten received isepamicin and six amikacin . Urine cultures grew Escherichia coli in all patients . All patients were treated successfully with either isepamicin or amikacin . Clinical and bacteriological response rates were 100 % for both groups . No adverse events occurred . Peak serum levels ranged from 9.05 to 30.70 mg/l ( median : 16.165 ) and from 12.20 to 25.90 mg/l ( median : 19.05 ) for isepamicin and amikacin , respectively . Trough serum levels ranged from 0.11 to 3.20 mg/l ( median : 0.75 ) and from 0.1 to 2.1 mg/l ( median : 0.655 ) , respectively . Isepamicin was shown to be as effective and safe as amikacin in the treatment of children with pyelonephritis and might prove an advantageous alternative in areas with high incidence of resistance to other aminoglycosides The efficacy and safety of isepamicin 7.5 mg/kg of body weight twice daily or amikacin the same dosage regimen for the treatment of various infections in neutropenic and non-neutropenic paediatric patients were compared in a prospect i ve r and omised trial . In total , 306 patients were enrolled and received at least one dose of r and omised treatment ( 204 isepamicin , 102 amikacin : intent-to-treat population ) ; 181 patients satisfied all criteria for evaluability ( 120 isepamicin , 61 amikacin : efficacy population ) . Clinical cure or improvement rates in the isepamicin and amikacin groups were : intent-to-treat population , 188/204 ( 92 % ) and 94/102 ( 92 % ) , respectively ; efficacy population , 117/120 ( 98 % ) and 58/61 ( 95 % ) , respectively . The bacteriological elimination rate ( efficacy population ) in the isepamicin and amikacin treatment groups was 75/76 ( 99 % ) vs 35/38 ( 92 % ) . Nephrotoxicity , defined as an increase in serum creatinine of 0.5 mg/dL or > or = 44.2 mumol/L from baseline , occurred in 4/187 ( 2 % ) and 1/191 ( 1 % ) children treated with isep Output:

In conclusion , isepamicin might be active in vitro against Gram-negative bacteria with resistance to amikacin and other aminoglycosides

MS2_1shot593

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal , family planning , and pediatric services in 12 public health clinics . Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits . METHODS The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline ( all clinics prior to the start of the intervention ) and an experimental period ( matchedpair r and om assignment of clinics to intervention or control conditions ) . Subjects were 683 ( baseline ) and 1,064 ( experimental ) smokers with measurements of smoking outcomes at both times . Mixed-effects regressions analyzed individual outcomes clustered within clinics and services . RESULTS Control and intervention clinics had similar outcomes in the baseline period . In the experiment , outcomes improved in the intervention but not in the control clinics . Compared to controls , smokers exposed to the intervention were more likely to have quit ( 14.5 versus 7.7 % ) or take actions toward quitting and had higher mean action , stage of readiness , and motivation to quit scores . These positive effects persisted when clustering within clinics and services was controlled . CONCLUSIONS This intervention , implemented by clinic personnel as part of routine medical visits , was effective under these natural conditions across different types of clinic service BACKGROUND Pediatric well-care visits provide a clinical opportunity to counsel new mothers about their smoking and the deleterious effects of environmental tobacco smoke ( ETS ) on infant health . METHODS Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or had quit for pregnancy , using a brief survey at the newborn 's first office visit . R and omly assigned offices provided advice and material s to mothers at each well-care visit during the first 6 months postpartum to promote quitting or relapse prevention . RESULTS The intervention reduced smoking ( 5.9 % vs 2.7 % ) and relapse ( 55 % vs 45 % ) at 6-month follow-up , but logistic regression analysis at 12 months revealed no significant treatment effect . The intervention had a positive effect on secondary outcome variables , such as readiness to quit and attitude toward and knowledge of ETS . Multiple logistic regression analysis indicated that husb and /partner smoking was the strongest predictor of maternal quitting or relapse . CONCLUSIONS A pediatric office-based intervention can significantly affect smoking and relapse prevention for mothers of newborns , but the effect decreases with time . Consistent prompting of the provider to give brief advice and material s at well-care visits could provide a low-cost intervention to reduce infant ETS exposure BACKGROUND Since most smoker parents of children with asthma are unable to quit , an alternative measure that would reduce their children 's exposure to environmental tobacco smoke ( ETS ) is to ban smoking in the home . METHODS Compared with 136 usual-care controls , 128 intervention-group parents recruited from South Australian pediatric hospital outpatient waiting rooms were given written and verbal feedback about their 1- to 11-year-old child 's urinary cotinine-to-creatinine level , information booklets , and two telephone calls encouraging a ban on smoking at home . RESULTS At 6 months , 49.2 % of the intervention group reported having banned smoking in the home compared with 41.9 % of controls , but the differential rate of change from baseline was not significant ( P = 0.40 ) . At follow-up , there were no significant differences between groups in the percentage reporting bans on smoking in the car , the mean reduction from baseline in total daily consumption or consumption in front of the child , children 's urinary cotinine level , or parental smoking cessation . CONCLUSIONS The intervention did not change parents ' propensity to create or maintain bans on smoking in their homes or otherwise change smoking habits to reduce their children 's exposure to ETS . More intensive interventions may be required to achieve change among low-income smoker parents of children with asthma OBJECTIVE To examine the effects of environmental tobacco smoke ( ETS ) on health services use in Chinese infants with nonsmoking mothers . DESIGN Prospect i ve , population -based birth cohort . SETTING General population of Hong Kong in 1997 - 1998 . PARTICIPANTS A total of 8327 parent-infant pairs who were followed up for 18 months . MAIN OUTCOME MEASURES Doctor consultations and hospitalizations . Results . After adjusting for the age , education level , and employment status of mothers-as well as infants ' birth weight , method of delivery , breastfeeding status , and birth order-ETS exposure through the mother in utero was positively associated with higher consultation ( adjusted odds ratio [ OR ] : 1.26 ; 95 % confidence interval [ CI ] : 1.14 , 1.39 ) and hospitalization ( OR : 1.18 ; 95 % CI : 1.05 , 1.31 ) use in infants with nonsmoking mothers attributable to any illness . In addition , postnatal exposure to ETS at home was linked to higher rates of hospitalizations for any illness compared with nonexposed infants ( OR : 1.12 ; 95 % CI : 1.00 , 1.25 ) , although the relationship did not hold for outpatient consultation visits . The OR for higher hospital use in infants exposed to 2 or more smokers at home was 1.30 ( 95 % CI : 1.08 , 1.58 ) . CONCLUSIONS The use of tobacco products by household members , even among nonsmoking mothers , has an enormous adverse impact on the health of children , as well as increases health services use and cost . The present data support the revision of public policy to reflect an evidence -based approach to the promotion of smoking cessation in all household members during and after pregnancy . environmental tobacco smoke , health services , infants Abstract Objective : To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke . Design : R and omised controlled trial . Setting : Tayside and Fife , Scotl and . Participants : 501 families with an asthmatic child aged 2 - 12 years living with a parent who smoked . Intervention : Parents were told about the impact of passive smoking on asthma and were advised to stop smoking or change their smoking habits to protect their child 's health . Main outcome measures : Salivary cotinine concentrations in children , and changes in reported smoking habits of the parents 1 year after the intervention . Results : At the second visit , about 1 year after the baseline visit , a small decrease in salivary cotinine concentrations was found in both groups of children : the mean decrease in the intervention group ( 0.70 ng/ml ) was slightly smaller than that of the control group ( 0.88 ng/ml ) , but the net difference of 0.19 ng/ml had a wide 95 % confidence interval ( −0.86 to 0.48 ) . Overall , 98 % of parents in both groups still smoked at follow up . However , there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking . Conclusions : A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children 's exposure to environmental tobacco smoke . The intervention may have made some parents less inclined to stop smoking . If a clinician believes that a child 's health is being affected by parental smoking , the parent 's smoking needs to be addressed as a separate issue from the child 's health . Key messages Many asthmatic children are exposed to high levels of environmental tobacco smoke A brief intervention informing parents of asthmatic children on the harmful effects of passive smoking did not lead to a reduction in exposure of their children to tobacco smoke Low rates of smoking cessation were found in both the intervention group and the control group Some parents may have been less inclined to stop smoking after the intervention Brief interventions requesting smokers to stop for another person 's health seem We conducted a r and omized controlled trial to determine whether a home-based intervention program could reduce infant passive smoking and lower respiratory illness . The intervention consisted of four nurse home visits during the first 6 months of life , design ed to assist families to reduce the infant 's exposure to tobacco smoke . Among the 121 infants of smoking mothers who completed the study , there was a significant difference in trend over the year between the intervention and the control groups in the amount of exposure to tobacco smoke ; infants in the intervention group were exposed to 5.9 fewer cigarettes per day at 12 months . There was no group difference in infant urine cotinine excretion . The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school : intervention group , 14.6 % ; and controls , 34.0 % Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences . An experimental design was used to evaluate a minimal-contact intervention aim ed at modifying parents ' smoking behavior in their homes . All subjects received counseling on the health effects of passive smoking and advice to quit smoking inside the home . Treatment subjects were also mailed the results of a urine cotinine test on their child and a self-help manual . More treatment ( 35 % ) than control ( 17 % ) subjects reported smoking outside their homes at posttest ( and their children 's cotinine levels were lower ) , but this difference was not statistically significant STUDY OBJECTIVE To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic children 's exposure to environmental tobacco smoke ( ETS ) . PARTICIPANTS Families of asthmatic children ( 6 to 17 years ) , including at least one parent who smoked in the home , recruited from four pediatric allergy clinics . DESIGN Participants were r and omized to one of three groups : behavioral counseling to reduce ETS exposure , self-monitoring control , and usual medical care control . Counseling concluded at month 6 , and the original trial ended at month 12 . Two follow-up interviews occurred at months 20 and 30 . MEASUREMENTS AND RESULTS The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure . The 2-year follow-up period was analyzed similarly . Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up . Further exploratory analyses suggested that printed counseling material s given to all participants at month 12 ( conclusion of the original study ) were associated with decreased exposure in the control groups . CONCLUSION Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature , let alone for addictive behaviors . We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit An information programme on measures to prevent passive smoking by children , design ed for use during well‐child visits , was tested . A total of 443 consecutive families with one or two smoking parents , attending mother and child health centres in Oslo , Norway , were r and omly allocated to an intervention group ( n= 221 ) and a control group ( n= 222 ) . Eighty families ( 18 % ) dropped out during the study period . For the intervention group , the communication between the health visitor and the family was prolonged at one well‐child visit with a brief session on smoking , and the parents were given three brochures . The families in the control group received no information on smoking . Changes in practical measures to prevent passive smoking by the children ( e.g. no smoking indoors ) as well as changes in daily smoking and smoking quantity were assessed by parental reports . We found no significant differences between the groups with respect to change in smoking behaviour BACKGROUND The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is a multistate field trial examining the effects of school environment , classroom curricula , and family intervention components in promoting the cardiovascular health of elementary school students . The purpose of this paper is to describe the CATCH tobacco use intervention and measurement , including the adoption of tobacco-free school policies . METHODS In this study , changes in school tobacco use policies and smoking experimentation among students were assessed . Smoking experimentation was measured in all CATCH schools when the students were in their fifth- grade year . A total of 6,527 subjects in 96 schools in California , Louisiana , Minnesota , and Texas answered questions about behaviors and potential correlates of smoking as part of the CATCH health behavior question naire in Spring 1994 . School tobacco use policy , an important complement to classroom- and home-based prevention efforts , was promoted as part of the CATCH intervention . The degree to which such policy was implemented was measured using surveys of school officials . RESULTS At the end of fifth grade , only 4.8 % of the subjects indicated that they had experimented with tobacco . School intervention condition was not a factor in the prediction of experimentation . Those whose best friend or sibling smoked , or who had ready access to cigarettes in the home , were more likely to have experimented with smoking . In the 3 years of the study , the percentages of tobacco-free schools went up from 49.7 to 76.8 % . Though differences in the rate of policy adoption could not be directly attributed to the CATCH intervention , the implementation of the tobacco-free schools ' policies did vary substantially from state to state . Minnesota and Texas , with stronger state laws supporting local policy , had nearly completely smoke-free schools . In spite of a statewide tobacco control initiative , California was slower to implement school policies . Louisiana , which allows local decision making regarding smoking policy , had the most difficulty establishing a policy for all districts . CONCLUSION Future studies should examine the impact of parallel policy interventions that are ongoing at both school and state levels . Tobacco-free policies appear to be a crucial part of school-based interventions Output:

REVIEW ER 'S CONCLUSIONS Brief counselling interventions , successful in the adult health setting when coming from physicians , can not be extrapolated to adults in the setting of child health . There is limited support for more intensive counselling interventions . There is no clear evidence for differences between the respiratory , non-respiratory ill child , well child and peripartum setting s as context s for reduction of children 's ETS exposure

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The likelihood of distant recurrence in patients with breast cancer who have no involved lymph nodes and estrogen-receptor-positive tumors is poorly defined by clinical and histopathological measures . METHODS We tested whether the results of a reverse-transcriptase-polymerase-chain-reaction ( RT-PCR ) assay of 21 prospect ively selected genes in paraffin-embedded tumor tissue would correlate with the likelihood of distant recurrence in patients with node-negative , tamoxifen-treated breast cancer who were enrolled in the National Surgical Adjuvant Breast and Bowel Project clinical trial B-14 . The levels of expression of 16 cancer-related genes and 5 reference genes were used in a prospect ively defined algorithm to calculate a recurrence score and to determine a risk group ( low , intermediate , or high ) for each patient . RESULTS Adequate RT-PCR profiles were obtained in 668 of 675 tumor blocks . The proportions of patients categorized as having a low , intermediate , or high risk by the RT-PCR assay were 51 , 22 , and 27 percent , respectively . The Kaplan-Meier estimates of the rates of distant recurrence at 10 years in the low-risk , intermediate-risk , and high-risk groups were 6.8 percent ( 95 percent confidence interval , 4.0 to 9.6 ) , 14.3 percent ( 95 percent confidence interval , 8.3 to 20.3 ) , and 30.5 percent ( 95 percent confidence interval , 23.6 to 37.4 ) . The rate in the low-risk group was significantly lower than that in the high-risk group ( P<0.001 ) . In a multivariate Cox model , the recurrence score provided significant predictive power that was independent of age and tumor size ( P<0.001 ) . The recurrence score was also predictive of overall survival ( P<0.001 ) and could be used as a continuous function to predict distant recurrence in individual patients . CONCLUSIONS The recurrence score has been vali date d as quantifying the likelihood of distant recurrence in tamoxifen-treated patients with node-negative , estrogen-receptor-positive breast cancer AIM --To evaluate the effect of the duration of formalin fixation and of tumour heterogeneity on quantitative estimates of oestrogen receptor content ( oestrogen receptor index ) and proliferative activity ( MIB-1 index ) in breast cancer . METHODS --Two monoclonal antibodies , MIB-1 and oestrogen receptor , were applied to formalin fixed , paraffin wax embedded tissue from 25 prospect ively collected oestrogen receptor positive breast carcinomas , using a microwave antigen retrieval method . Tumour tissue was allocated systematic ally to different periods of fixation to ensure minimal intraspecimen variation . The percentages of MIB-1 positive and oestrogen receptor positive nuclei were estimated in fields of vision sample d systematic ally from the entire specimen and from the whole tumour area of one " representative " cross-section . RESULTS --No correlation was found between the oestrogen receptor and MIB-1 indices and the duration of formalin fixation . The estimated MIB-1 and oestrogen receptor indices in tissue sample d systematic ally from the entire tumour were closely correlated with estimates obtained in a " representative " section . The intra- and interobserver correlation of the MIB-1 index was good , although a slight systematic al error at the second assessment of the intraobserver study was noted . CONCLUSION --Quantitative estimates of oestrogen receptor content and proliferative activity are not significantly influenced by the period of fixation in formalin , varying from less than four hours to more than 48 hours . The MIB-1 and the oestrogen receptor indices obtained in a " representative " section do not deviate significantly from average indices determined in tissue sample s from the entire tumour . Finally , the estimation of MIB-1 index is reproducible , justifying its routine use OBJECTIVE To evaluate prospect ively the degree of correlation between immunocytochemical ( ICC ) and immunohistochemical ( IHC ) determination of estrogen ( ER ) and progesterone receptors ( PR ) in breast cancer . STUDY DESIGN Fine needle aspiration cytology ( FNAC ) of 101 primary breast cancers were immunostained for ER and PR . They were compared with similar determinations in formalin-fixed paraffin sections of biopsies from the same patients . In cases of discrepancy , the histologic result was considered the gold st and ard . RESULTS For ER a cytohistologic correlation of 94 % , with a sensitivity of 96.1 % and specificity of 86.9 % , was found . For PR the cytohistologic correlation was 71.2 % , with a sensitivity of 65.7 % and specificity of 83.8 % . CONCLUSION ICC determination of hormone receptors in routinely fixed smears obtained by FNAC is a simple method that correlates adequately with the results of IHC determinations , especially for ER Purpose Primary chemotherapy provides an ideal opportunity to correlate gene expression with response to treatment . We used paraffin-embedded core biopsies from a completed phase II trial to identify genes that correlate with response to primary chemotherapy . Patients and Methods Patients with newly diagnosed stage II or III breast cancer were treated with sequential doxorubicin 75 mg/M2 q2 wks × 3 and docetaxel 40 mg/M2 weekly × 6 ; treatment order was r and omly assigned . Pretreatment core biopsy sample s were interrogated for genes that might correlate with pathologic complete response ( pCR ) . In addition to the individual genes , the correlation of the Oncotype DX Recurrence Score with pCR was examined . Results Of 70 patients enrolled in the parent trial , core biopsies sample s with sufficient RNA for gene analyses were available from 45 patients ; 9 ( 20 % ) had inflammatory breast cancer ( IBC ) . Six ( 14 % ) patients achieved a pCR . Twenty-two of the 274 c and i date genes assessed correlated with pCR ( p < 0.05 ) . Genes correlating with pCR could be grouped into three large clusters : angiogenesis-related genes , proliferation related genes , and invasion-related genes . Expression of estrogen receptor (ER)-related genes and Recurrence Score did not correlate with pCR . In an exploratory analysis we compared gene expression in IBC to non-inflammatory breast cancer ; twenty-four ( 9 % ) of the genes were differentially expressed ( p < 0.05 ) , 5 were upregulated and 19 were downregulated in IBC . Conclusion Gene expression analysis on core biopsy sample s is feasible and identifies c and i date genes that correlate with pCR to primary chemotherapy . Gene expression in IBC differs significantly from noninflammatory breast cancer The 21‐gene recurrence score ( RS ) assay has been reported to accurately predict the risk of disease recurrence and chemotherapy benefit in women with estrogen receptor (ER)‐positive , lymph node (LN)‐negative breast cancer who are treated with tamoxifen . To the authors ' knowledge , the association between the RS and clinicopathologic characteristics has been studied in r and omized and case‐control trials , but not in the general population PURPOSE To develop a guideline to improve the accuracy of immunohistochemical ( IHC ) estrogen receptor ( ER ) and progesterone receptor ( PgR ) testing in breast cancer and the utility of these receptors as predictive markers . METHODS The American Society of Clinical Oncology and the College of American Pathologists convened an international Expert Panel that conducted a systematic review and evaluation of the literature in partnership with Cancer Care Ontario and developed recommendations for optimal IHC ER/PgR testing performance . RESULTS Up to 20 % of current IHC determinations of ER and PgR testing worldwide may be inaccurate ( false negative or false positive ) . Most of the issues with testing have occurred because of variation in preanalytic variables , thresholds for positivity , and interpretation criteria . RECOMMENDATIONS The Panel recommends that ER and PgR status be determined on all invasive breast cancers and breast cancer recurrences . A testing algorithm that relies on accurate , reproducible assay performance is proposed . Elements to reliably reduce assay variation are specified . It is recommended that ER and PgR assays be considered positive if there are at least 1 % positive tumor nuclei in the sample on testing in the presence of expected reactivity of internal ( normal epithelial elements ) and external controls . The absence of benefit from endocrine therapy for women with ER-negative invasive breast cancers has been confirmed in large overviews of r and omized clinical trials Progesterone receptor is a surrogate marker of estrogen receptor activity in breast cancer and its utility in helping predict clinical outcome has been established using biochemical assays . However , most laboratories worldwide have switched to immunohistochemistry to assess progesterone receptor , but unfortunately no vali date d immunohistochemical assay exists for progesterone receptor . The purpose of this study was to develop and vali date an immunohistochemical assay for progesterone receptor in breast cancer . The assay was based on monoclonal antibody 1294 ( DakoCytomation ) and slides were scored microscopically using the ‘ Allred score ’ on a scale of 0–8 . The assay was compared to lig and -binding assay in 1235 breast cancers , and a subset ( n=362 ) that received only hormonal therapy was used to define a cutoff for progesterone receptor-positive . Clinical utility was vali date d in an independent set of sample s ( n=423 ) from a clinical trial r and omizing premenopausal breast cancer patients to tamoxifen+oophorectomy vs observation following surgery . A cutoff of > 2 ( corresponding to > 1 % positive cells ) dichotomized patients with significantly better or worse clinical outcome ( P=0.0014 ) . Progesterone receptor by immunohistochemistry provided significantly better results than progesterone receptor by lig and -binding assay in predicting clinical outcome . In the clinical trial , a positive result in univariate analyses was associated with significantly improved disease-free and overall survival both in untreated ( hazard ratios/P=0.656/0.060 and 0.479/0.005 , respectively ) and hormonally treated patients ( hazard ratios/P=0.529/0.017 and 0.451/0.007 , respectively ) . Positive progesterone receptor remained significant for improved disease-free and overall survival ( hazard ratios/P=0.666/0.038 and 0.549/0.007 , respectively ) in multivariate analyses including the st and ard variables of tumor size , nodal status , treatment , histological grade , and HER-2/neu status . Estrogen and progesterone receptors are codependent variables and progesterone receptor was a weaker predictor of response to endocrine therapy than estrogen receptor when both were included in multivariate analysis . This is the first comprehensive study assessing the clinical usefulness of progesterone receptor by immunohistochemistry in archival tissue in breast cancer . Progesterone receptor assessed by immunohistochemistry provides useful information about clinical outcome and it is better than progesterone receptor measured by lig and -binding assay Purpose : Tamoxifen has long been the drug of choice in adjuvant endocrine therapy of steroid hormone receptor – positive breast cancer , and it still remains important due to its well-documented beneficial effect . Hormone receptor status is often reported as “ positive ” or “ negative ” using 10 % positive nuclei as a cutoff . In this study , we aim ed to assess whether a further subclassification of hormone receptor status could enhance the treatment predictive value . Experimental Design : The immunohistochemical expression of estrogen receptor ( ER ) and progesterone receptor ( PR ) was quantified in tissue microarrays with tumors from 500 premenopausal breast cancer patients previously included in a r and omized trial of adjuvant tamoxifen compared with an untreated control group . Results : Our findings show a gradually increasing tamoxifen effect in tumors with > 10 % ER-positive nuclei . However , when analyzing tamoxifen response according to various PR fractions , we found that it was primarily patients with tumors showing > 75 % PR-positive nuclei that responded to tamoxifen treatment , with an improved recurrence-free [ relative risk , 0.42 ( 0.25 - 0.70 ) ; P = 0.001 ] as well as overall [ relative risk , 0.49 ( 0.28 - 0.84 ) ; P = 0.010 ] survival . Conclusions : Adjuvant tamoxifen improved recurrence-free and overall survival for premenopausal patients with tumors showing > 75 % PR-positive nuclei . No effect could be shown in tumors with fewer PR-positive nuclei . The PR was a stronger predictor of treatment response than the ER . Based on these findings , we suggest the implementation of a fractioned rather than dichotomized immunohistochemical evaluation of hormone receptors in clinical practice , possibly with greater emphasis on the PR than the ER Aim : To quantify the changes in biological molecular markers during primary medical treatment in patients with operable breast cancer and to assess their possible relationship with response to treatment . Methods : The treatment group consisted of 31 patients with operable breast carcinomas , median age 57 years ( range 41–67 ) , treated with four 3‐weekly cycles of chemotherapy with Mitoxantrone , methotrexate ( ± mitomycin C ) , and tamoxifen before surgery . Fine needle aspiration ( FNA Output:

It is anticipated that widespread adoption of these guidelines will further improve the accuracy of hormone receptor testing in Canada

MS2_1shot595

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Disseminated intravascular coagulation ( DIC ) is a serious complication of sepsis that is associated with a high mortality . OBJECTIVES Using the adapted International Society on Thrombosis and Haemostasis ( ISTH ) diagnostic scoring algorithm for DIC , we evaluated the treatment effects of high-dose antithrombin ( AT ) in patients with severe sepsis with or without DIC . PATIENTS AND METHODS From the phase III clinical trial in severe sepsis ( KyberSept ) , 563 patients were identified ( placebo , 277 ; AT , 286 ) who did not receive concomitant heparin and had sufficient data for DIC determination . RESULTS At baseline , 40.7 % of patients ( 229 of 563 ) had DIC . DIC in the placebo-treated patients was associated with an excess risk of mortality ( 28-day mortality : 40.0 % vs. 22.2 % , P < 0.01 ) . AT-treated patients with DIC had an absolute reduction in 28-day mortality of 14.6 % compared with placebo ( P = 0.02 ) whereas in patients without DIC no effect on 28-day mortality was seen ( 0.1 % reduction in mortality ; P = 1.0 ) . Bleeding complications in AT-treated patients with and without DIC were higher compared with placebo ( major bleeding rates : 7.0 % vs. 5.2 % for patients with DIC , P = 0.6 ; 9.8 % vs. 3.1 % for patients without DIC , P = 0.02 ) . CONCLUSIONS High-dose AT without concomitant heparin in septic patients with DIC may result in a significant mortality reduction . The adapted ISTH DIC score may identify patients with severe sepsis who potentially benefit from high-dose AT treatment Patients with fulminant hepatic failure have severe circulatory disturbances which may be due to fibrin and cellular plugs in micro-vessels which are a consequence of intravascular coagulation and which can lead to multiorgan failure . Since antithrombin III supplementation has been shown to be beneficial in animal models of septic shock with disseminated intravascular coagulation , a controlled study was performed to investigate the effect of antithrombin III supplementation in fulminant hepatic failure . Twenty-five patients in grade III or IV coma were selected on the basis of evidence of sepsis , intravascular coagulation and a high risk of developing multiorgan failure . Thirteen patients received 3000 units of antithrombin III ( Kybernin P ; Behringwerke ) , followed by a further 1000 units every 6 h. Antithrombin III activity increased from 0.26 + /- 0.04 SE U/ml to 0.82 + /- 0.07 U/ml at 3 h post infusion ( normal range 0.80 - 1.20 U/ml ) and remained greater than 0.80 U/ml throughout the study without any apparent increase in the frequency of bleeding . However , survival was not improved and markers of intravascular coagulation remained similar between the two groups . Thus , although the antithrombin III deficiency in fulminant hepatic failure can be corrected by supplementation with antithrombin III concentrate , its use in the prevention of intravascular coagulation and to avoid microvessel plugging needs to be studied at an earlier stage in the disease Objectives : To evaluate the safety , pharmacokinetics , and the practicability of two different antithrombin III ( AT III ) high-dose regimens in patients with severe sepsis.¶ Design : Prospect i ve , open , r and omized , 2 parallel groups , multinational clinical trial.¶ Setting : Eleven academic medical center intensive care units ( ICU ) in Austria , Belgium , Denmark , Germany , Norway and Sweden.¶ Patients : Thirty-three patients with severe sepsis who received st and ard supportive care and antimicrobial therapy , in addition to the administration of AT III.¶ Interventions : Patients received an intravenous loading dose of 6,000 IU AT III followed by either intermittent bolus infusions of 1,000 IU AT III every 4 h or a continuous infusion of 250 IU AT III/h for 4 days , result ing in a total dose for both dosage regimens of 30,000 IU AT III.¶ Measurements : All patients were evaluated for safety and all but one for pharmacokinetics.¶ Results and conclusions : The administration of AT III was safe and well tolerated . The overall 28-day all-cause mortality was 30 % ( 43 % intermittent bolus infusions ; 21 % continuous infusion ) . The mean probability of dying according to the SAPS II was 48 % . The difference in mortality between both groups was within the range of chance . AT III plasma levels were elevated from low baseline levels to above 120 % soon after onset of AT III therapy and remained at these levels for the treatment phase of 4 days . Functional and immunologic levels of AT III corresponded very well . With an overall median volume of distribution of 4.5 l ( range : 2.4–6.5 l ) , AT III only moderately extended beyond plasma . The overall median elimination half-life was 18.6 h ( range : 5.1–37.4 ) . Overall , median response was 1.75 % per IU/kg ( range : 1.14–2.8).¶The variability of elimination parameters was quite noteworthy ( CV = 41–59 % ) , whereas distribution-related parameters showed a moderate variability ( CV = 24 % ) . In spite of this variability , both high-dose IV regimens reliably provided AT III levels above 120 % for all but one patient . An increased mortality was observed for patients with a distribution volume exceeding 4.5 l ( or a response < 1.7 % per IU/kg ) . AT III distribution volumes above 4.5 l might indicate a capillary leak phenomenon . The continuous infusion regimen was slightly preferred by the investigators with regard to practicability Activation of thrombin and of the coagulation system plays an important role in the pathophysiology of sepsis-associated organ dysfunction . Antithrombin III ( AT III ) is a natural inhibitor of thrombin , a central procoagulatory factor with pleiotropic activities . Experimental supplementation of AT III improved coagulation parameters and ameliorated organ dysfunction . To determine whether long-term AT III supplementation has beneficial effects on organ function , we conducted a r and omized , prospect i ve study in surgical patients with severe sepsis . The study evaluated the long-term effect of AT III supplementation ( duration of treatment : 14 days ) . After r and omization ( AT III vs. control group ) , AT III was infused continuously over 14 days to obtain plasma AT III activities > 120 % . Forty consecutive patients were recruited ( 20 AT III/20 control group ) . Eleven patients had a rapid fatal course and did not met the criterion of a 14 day treatment period . From these 11 patients , 8 patients ( 5 AT III/3 control group ) died within 72 h due to septic shock . The remaining 14 AT III patients and 15 controls survived 14 days and showed no differences in baseline parameters of organ function . AT III caused a disappearance of disseminated intravascular coagulation ( DIC ) in all patients with DIC , whereas in control patients , the frequency of DIC remained constant ( p < .05 ) . In AT III patients a progressive increase in oxygenation index ( Pao2/Fio2 ratio ) and a continuous decrease in pulmonary hypertension index ( mean pulmonary artery pressure/mean arterial pressure ( PAP/MAP ) ratio ) indicated an improvement of lung function ( p < .05 vs. control ) . AT III prevented the continuous rise in total serum bilirubin concentration observed in control patients and diminished the frequency of artificial renal support therapy ( p < .05 ) . Long-term supplementation with AT III may improve lung function and prevent the development of septic liver and kidney failure in patients with severe sepsis A prospect i ve , r and omized , controlled trial to examine the effects of antithrombin supplementation on mortality , coagulation and renal function has been carried out on 132 intensive care patients . Antithrombin activity was measured in all patients on admission to the intensive care unit ( ICU ) . Patients with an antithrombin activity of less than 70 % were r and omized to either receive antithrombin replacement or to act as controls . Antithrombin activity was maintained above 70 % in the treated patients throughout their stay on ICU . Ninety-three patients had an antithrombin activity of less than 70 % and 35 received replacement therapy . Patients with antithrombin activity below 70 % remained on the ICU significantly longer and had a significantly higher mortality rate than patients with antithrombin activity above 70 % . Antithrombin supplementation neither reduced mortality nor shortened the intensive care stay . Fifty patients with reduced antithrombin activity remained on the ICU for at least 4 days , 25 received antithrombin and 25 acted as controls ; coagulation parameters and renal function have been monitored in these patients . Fibrinogen concentration and platelet count were unaffected by antithrombin replacement . Antithrombin supplementation did not appear to reduce the incidence of impaired renal function in sepsis , trauma and postoperative patients . The creatinine clearance fell below 20 ml/min in eight patients in the no-treatment arm while by comparison only three patients in the treatment arm developed impaired renal function . Our study does not demonstrate a clear role for the use of antithrombin supplementation in intensive care , however the finding that antithrombin reduced renal impairment is encouraging and a larger study to confirm this finding is at present underway CONTEXT Activation of the coagulation system and depletion of endogenous anticoagulants are frequently found in patients with severe sepsis and septic shock . Diffuse microthrombus formation may induce organ dysfunction and lead to excess mortality in septic shock . Antithrombin III may provide protection from multiorgan failure and improve survival in severely ill patients . OBJECTIVE To determine if high-dose antithrombin III ( administered within 6 hours of onset ) would provide a survival advantage in patients with severe sepsis and septic shock . DESIGN AND SETTING Double-blind , placebo-controlled , multicenter phase 3 clinical trial in patients with severe sepsis ( the KyberSept Trial ) was conducted from March 1997 through January 2000 . PATIENTS A total of 2314 adult patients were r and omized into 2 equal groups of 1157 to receive either intravenous antithrombin III ( 30 000 IU in total over 4 days ) or a placebo ( 1 % human albumin ) . MAIN OUTCOME MEASURE All-cause mortality 28 days after initiation of study medication . RESULTS Overall mortality at 28 days in the antithrombin III treatment group was 38.9 % vs 38.7 % in the placebo group ( P = .94 ) . Secondary end points , including mortality at 56 and 90 days and survival time in the intensive care unit , did not differ between the antithrombin III and placebo groups . In the subgroup of patients who did not receive concomitant heparin during the 4-day treatment phase ( n = 698 ) , the 28-day mortality was nonsignificantly lower in the antithrombin III group ( 37.8 % ) than in the placebo group ( 43.6 % ) ( P = .08 ) . This trend became significant after 90 days ( n = 686 ; 44.9 % for antithrombin III group vs 52.5 % for placebo group ; P = .03 ) . In patients receiving antithrombin III and concomitant heparin , a significantly increased bleeding incidence was observed ( 23.8 % for antithrombin III group vs 13.5 % for placebo group ; P<.001 ) . CONCLUSIONS High-dose antithrombin III therapy had no effect on 28-day all-cause mortality in adult patients with severe sepsis and septic shock when administered within 6 hours after the onset . High-dose antithrombin III was associated with an increased risk of hemorrhage when administered with heparin . There was some evidence to suggest a treatment benefit of antithrombin III in the subgroup of patients not receiving concomitant heparin AT-III LLC , a joint venture between Genzyme Transgenics ( GTC ) and Genzyme General , is developing transgenic recombinant human antithrombin III ( rhAT-III ) as a potential treatment for sepsis and other disorders involving thrombosis . It is in phase III clinical trials in the US and Europe as an anticoagulant in patients undergoing elective cardiac surgery such as cardiopulmonary bypass Objective : Sepsis is frequently associated with coagulatory activation , which may contribute to deteriorated organ function . Antithrombin is one important endogenous coagulation inhibitor that is therapeutically applied during sepsis . This study investigates the effect of 14-day antithrombin application on coagulatory variables . Design : Prospect i ve study . Setting : Surgical intensive care unit of a university hospital . Patients : Forty patients with severe sepsis . Interventions : Patients with severe sepsis were r and omly assigned to receive either conventional intensive care treatment ( n = 20 , controls ) or antithrombin substitution that aim ed at a plasma antithrombin activity ≥120 % during a long-term ( 14-day ) study period ( n = 20 , antithrombin ) . To allow comparative analysis of laboratory variables over time , all patients who did not survive the 14-day-period ( five controls and six antithrombin Output:

In sepsis patients with DIC , administration of antithrombin concentrate may increase overall survival .

MS2_1shot596

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Extended sitting time at work is viewed as a crucial public health issue . Encouraging workers to st and during their office hours via the installation of st and ing desks maybe one effective option to combat this . Here , we investigate whether the installation of high desks in the workplace can induce positive changes in the amount of physical activity ( PA ) and thereby lead to subsequent improvements in anthropometric parameters . Methods Thirty-two white-collar workers ( 22 men and 10 women , mean age 44.2 ) were r and omly divided into two groups . A r and omised crossover trial was performed for 13 weeks . During the experimental period , subjects completed their office work in a st and ing position using stationary high desks ( st and ing work , SW ) for 10 hours per week or more ( SW period ) . The subjects were asked to maintain their normal sitting working habits during the control period ( CONT period ) . The primary outcome was PA , which was assessed objective ly using a triaxial accelerometer during weekdays and weekends . The secondary outcomes were anthropometric measurements . For each group and each parameter , the mean values during each period were recorded and were compared by paired t test . Results The daily total PA ( 10.2 ± 2.4 vs. 9.7 ± 2.3 METs · h/day , P = 0.043 ) , MVPA ( 4.2 ± 2.2 vs. 3.7 ± 1.8 METs · h/day , P = 0.025 ) , time spent in moderate PA ( 58.2 ± 20.7 vs. 53.4 ± 17.0 min/day , P = 0.019 ) and time spent in MVPA ( 62.8 ± 25.1 vs. 57.0 ± 20.3 min/day , P = 0.019 ) were significantly higher during the SW period compared to the CONT period . A weekdays verses weekends sub analysis revealed that these parameters were significantly higher during the SW period compared to the CONT period during weekdays only . No significant differences were noted before and after SW periods for most of the anthropometric measures , except waist circumference ( 83.7 ± 7.9 vs. 83.0 ± 7.9 cm , respectively , P = 0.007 ) . Conclusions St and ing work , via the installation of high desks , significantly increases moderate to vigorous physical activity , especially on weekdays . Trial registration UMIN-CRT , UMIN000016731 , 7th March 2015 Purpose Encouraging office workers to ‘ sit less and move more ’ encompasses two public health priorities . However , there is little evidence on the effectiveness of workplace interventions for reducing sitting , even less about the longer term effects of such interventions and still less on dual-focused interventions . This study assessed the short and mid-term impacts of a workplace web-based intervention ( Walk@WorkSpain , W@WS ; 2010 - 11 ) on self-reported sitting time , step counts and physical risk factors ( waist circumference , BMI , blood pressure ) for chronic disease . Methods Employees at six Spanish university campuses ( n=264 ; 42±10 years ; 171 female ) were r and omly assigned by worksite and campus to an Intervention ( used W@WS ; n=129 ; 87 female ) or a Comparison group ( maintained normal behavior ; n=135 ; 84 female ) . This phased , 19-week program aim ed to decrease occupational sitting time through increased incidental movement and short walks . A linear mixed model assessed changes in outcome measures between the baseline , ramping ( 8 weeks ) , maintenance ( 11 weeks ) and follow-up ( two months ) phases for Intervention versus Comparison groups . Results A significant 2 ( group ) × 2 ( program phases ) interaction was found for self-reported occupational sitting ( F[3]=7.97 , p=0.046 ) , daily step counts ( F[3]=15.68 , p=0.0013 ) and waist circumference ( F[3]=11.67 , p=0.0086 ) . The Intervention group decreased minutes of daily occupational sitting while also increasing step counts from baseline ( 446±126 ; 8,862±2,475 ) through ramping ( + 425±120 ; 9,345±2,435 ) , maintenance ( + 422±123 ; 9,638±3,131 ) and follow-up ( + 414±129 ; 9,786±3,205 ) . In the Comparison group , compared to baseline ( 404±106 ) , sitting time remained unchanged through ramping and maintenance , but decreased at follow-up ( -388±120 ) , while step counts diminished across all phases . The Intervention group significantly reduced waist circumference by 2.1cms from baseline to follow-up while the Comparison group reduced waist circumference by 1.3cms over the same period . Conclusions W@WS is a feasible and effective evidence -based intervention that can be successfully deployed with sedentary employees to elicit sustained changes on “ sitting less and moving more ” Background Excessive sitting time is a risk factor for cardiovascular disease mortality and morbidity independent of physical activity . This aim of this study was to evaluate the impact of a sit-st and workstation on sitting time , and vascular , metabolic and musculoskeletal outcomes in office workers , and to investigate workstation acceptability and feasibility . Methods A two-arm , parallel-group , individually r and omised controlled trial was conducted in one organisation . Participants were asymptomatic full-time office workers aged ≥18 years . Each participant in the intervention arm had a sit-st and workstation installed on their workplace desk for 8 weeks . Participants in the control arm received no intervention . The primary outcome was workplace sitting time , assessed at 0 , 4 and 8 weeks by an ecological momentary assessment diary . Secondary behavioural , cardiometabolic and musculoskeletal outcomes were assessed . Acceptability and feasibility were assessed via question naire and interview . ANCOVA and magnitude-based inferences examined intervention effects relative to controls at 4 and 8 weeks . Participants and research ers were not blind to group allocation . Results Forty-seven participants were r and omised ( intervention n = 26 ; control n = 21 ) . Relative to the control group at 8 weeks , the intervention group had a beneficial decrease in sitting time ( −80.2 min/8-h workday ( 95 % CI = −129.0 , −31.4 ) ; p = 0.002 ) , increase in st and ing time ( 72.9 min/8-h workday ( 21.2 , 124.6 ) ; p = 0.007 ) and decrease in total cholesterol ( −0.40 mmol/L ( −0.79 , −0.003 ) ; p = 0.049 ) . No harmful changes in musculoskeletal discomfort/pain were observed relative to controls , and beneficial changes in flow-mediated dilation and diastolic blood pressure were observed . Most participants self-reported that the workstation was easy to use and their work-related productivity did not decrease when using the device . Factors that negatively influenced workstation use were workstation design , the social environment , work tasks and habits . ConclusionS hort-term use of a feasible sit-st and workstation reduced daily sitting time and led to beneficial improvements in cardiometabolic risk parameters in asymptomatic office workers . These findings imply that if the observed use of the sit-st and workstations continued over a longer duration , sit-st and workstations may have important ramifications for the prevention and reduction of cardiometabolic risk in a large proportion of the working population .Trial registration Clinical Trials.gov NCT02496507 Background Excessive time spent in sedentary behaviours ( sitting or lying with low energy expenditure ) is associated with an increased risk for type 2 diabetes , cardiovascular disease and some cancers . Desk-based office workers typically accumulate high amounts of daily sitting time , often in prolonged unbroken bouts . The St and Up Victoria study aims to determine whether a 3-month multi-component intervention in the office setting reduces workplace sitting , particularly prolonged , unbroken sitting time , and results in improvements in cardio-metabolic biomarkers and work-related outcomes , compared to usual practice . Methods / Design A two-arm cluster-r and omized controlled trial ( RCT ) , with worksites as the unit of r and omization , will be conducted in 16 worksites located in Victoria , Australia . Work units from one organisation ( Department of Human Services , Australian Government ) will be allocated to either the multi-component intervention ( organisational , environmental [ height-adjustable workstations ] , and individual behavioural strategies ) or to a usual practice control group . The recruitment target is 160 participants ( office-based workers aged 18–65 years and working at least 0.6 full time equivalent ) per arm . At each assessment ( 0- [ baseline ] , 3- [ post intervention ] , and 12-months [ follow-up ] ) , objective measurement via the activPAL3 activity monitor will be used to assess workplace : sitting time ( primary outcome ) ; prolonged sitting time ( sitting time accrued in bouts of ≥30 minutes ) ; st and ing time ; sit-to-st and transitions ; and , moving time . Additional outcomes assessed will include : non-workplace activity ; cardio-metabolic biomarkers and health indicators ( including fasting glucose , lipids and insulin ; anthropometric measures ; blood pressure ; and , musculoskeletal symptoms ) ; and , work-related outcomes ( presenteeism , absenteeism , productivity , work performance ) . Incremental cost-effectiveness and identification of both workplace and individual-level mediators and moderators of change will also be evaluated . Discussion St and Up Victoria will be the first cluster- RCT to evaluate the effectiveness of a multi-component intervention aim ed at reducing prolonged workplace sitting in office workers . Strengths include the objective measurement of activity and assessment of the intervention on markers of cardio-metabolic health . Health- and work-related benefits , as well as the cost-effectiveness of the intervention , will help to inform future occupational practice .Trial registration BACKGROUND Sedentary behavior is a risk factor for cardiometabolic disease . Regularly interrupting sedentary behavior with activity breaks may lower this risk . OBJECTIVE We compared the effects of prolonged sitting , continuous physical activity combined with prolonged sitting , and regular activity breaks on postpr and ial metabolism . DESIGN Seventy adults participated in a r and omized crossover study . The prolonged sitting intervention involved sitting for 9 h , the physical activity intervention involved walking for 30 min and then sitting , and the regular-activity-break intervention involved walking for 1 min 40 s every 30 min . Participants consumed a meal-replacement beverage at 60 , 240 , and 420 min . RESULTS The plasma incremental area under the curve ( iAUC ) for insulin differed between interventions ( overall P < 0.001 ) . Regular activity breaks lowered values by 866.7 IU · L(-1 ) · 9 h(-1 ) ( 95 % CI : 506.0 , 1227.5 IU · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with prolonged sitting and by 542.0 IU · L(-1 ) · 9 h(-1 ) ( 95 % CI : 179.9 , 904.2 IU · L(-1 ) · 9 h(-1 ) ; P = 0.003 ) when compared with physical activity . Plasma glucose iAUC also differed between interventions ( overall P < 0.001 ) . Regular activity breaks lowered values by 18.9 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 10.0 , 28.0 mmol · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with prolonged sitting and by 17.4 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 8.4 , 26.3 mmol · L(-1 ) · 9 h(-1 ) ; P < 0.001 ) when compared with physical activity . Plasma triglyceride iAUC differed between interventions ( overall P = 0.023 ) . Physical activity lowered values by 6.3 mmol · L(-1 ) · 9 h(-1 ) ( 95 % CI : 1.8 , 10.7 mmol · L(-1 ) · 9 h(-1 ) ; P = 0.006 ) when compared with regular activity breaks . CONCLUSION Regular activity breaks were more effective than continuous physical activity at decreasing postpr and ial glycemia and insulinemia in healthy , normal-weight adults . This trial was registered with the Australian New Zeal and Clinical Trials registry as ACTRN12610000953033 BACKGROUND Sit-st and desks reduce workplace sitting time among healthy office workers ; however , their metabolic and behavioral impact in higher risk population s remains unknown . METHODS 25 office workers with abdominal obesity were r and omized to an intervention ( sit-st and workstation ) or control group ( seated desk ) for 12 weeks . Physical activity , sedentary behavior , and cardiometabolic risk factors were assessed before and after the intervention period in both groups . RESULTS In comparison with the control group , which did not change , the intervention group experienced significant reductions in workday ( 344 ± 107 to 186 ± 101 min/day ) and total ( 645 ± 140 to 528 ± 91 min/day ) sitting time , as well as increases in work Output:

The BCTs of social comparison , problem solving , demonstration of the behaviour , goal setting ( behaviour ) , behaviour substitution , and habit reversal , demonstrated moderate to high promise ratios . Workplace interventions show promise for improving cardiometabolic risk markers . The BCTs with the greatest promise of cardiometabolic risk marker improvements included social comparison , those related to individual habits , and behaviour goals .

MS2_1shot597

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: In a clinical double-blind study , the analgesic efficacy and the side-effects of nimesulide ( Aulin , CAS 51803 - 78 - 2 ) and naproxen administered to 68 patients affected by advanced cancer pain were compared . Patients were treated with non-steroidal anti-inflammatory drugs according to the first step of the pharmacological analgesic scale of the WHO . The dose administered was 200 mg b.i.d . ( every 12 h ) for nimesulide and 500 mg b.i.d . ( every 12 h ) for naproxen . From this study the analgesic effect and the tolerability of the two drugs appeared to be similar . Both drugs result ed to be effective with a low incidence of adverse events that may be related to their use The analgesic efficacy of ketorolac tromethamine was compared to placebo in 126 patients suffering moderate or severe chronic pain due to cancer in a double-blind parallel r and omized study . Ketorolac was administered intramuscularly in doses of 10 , 30 or 90 mg . Pain intensity and pain relief were assessed for 6 hours by scoring st and ard verbal scales and an overall assessment of the medication was given by the patients and the observer on completion of the study . Each dose of ketorolac was statistically superior to placebo for the sum of pain intensity difference ( SPID ) but no difference was seen between the three ketorolac regimens . When the ketorolac groups are combined , there was a significantly better pain relief as compared to placebo . The global evaluation scores were also statistically superior in the ketorolac groups combined than in the placebo group . A total of 15 patients reported minor adverse events , 10 being after ketorolac doses . This study shows that single intramuscular doses of ketorolac of 10 mg and above are effective in the relief of cancer pain , and are associated with a low incidence of side-effects Abstract Variability in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size The role of non-steroidal anti-inflammatory drugs ( NSAIDs ) in cancer pain has been well established in the treatment of mild pain and in association with opioids in the treatment of moderate to severe pain . The aim of this study was to verify the effects of NSAIDs on morphine escalation in advanced cancer patients with pain followed-up at home and to assess the pharmacoeconomic implication s. A prospect i ve r and omised controlled study was carried out in 156 consecutive advanced cancer patients with pain followed-up at home in the period December 1999-December 2000 . In this group of patients , 47 were selected with pain progression after 1 week of opioid stabilisation . Patients were r and omly assigned to one of two groups : group ' O ' patients were treated with continuing opioid escalation according to their clinical needs ; group ' OK ' received ketorolac 60 mg/daily orally ( p.o . ) in three doses and then continued opioid escalation according to their clinical situation . Performance status , doses of morphine before and after starting treatment , mean weekly pain intensity ( assessed by means of a numerical scale from 0 to 10 ) , mean weekly symptoms intensity , adverse effects and pain mechanisms were recorded . Moreover , drug costs per day in both groups were calculated . Patients who received ketorolac in addition to morphine showed a better analgesia after a week in comparison to the group treated with morphine only ( P=0.005 ) . Thereafter , morphine escalation was slower and the maximum morphine dose was lower in the group treated with ketorolac . The incidence and the severity of gastric discomfort was more evident in patients treated with ketorolac , while constipation was significantly increased in patients who received morphine only . Drug costs per day were similar in both groups ; statistical differences were observed in patients who started on lower morphine doses ( < 100 mg/daily ) in the two groups ( 4.3 in the ketorolac-morphine group versus 3.4 in the morphine group ; P=0.012 ) . The use of NSAIDs reduces the need for an opioid dose escalation or allows the use of lower doses . Their use is associated with a more intense gastric discomfort , but results in less opioid-related constipation . The eventual additive cost for NSAIDs therapy is negligible , especially in patients taking high doses of morphine & NA ; A prospect i ve double‐blind r and omized trial was conducted on 184 cancer patients with moderate to severe chronic pain to evaluate the analgesic efficacy and tolerability of diclofenac alone ( 50 mg q.i.d . ) or in combination with a weak opioid ( codeine 40 mg q.i.d . ) , or with an anti‐depressant ( imipramine , 10 or 25 mg t.i.d . ) . All demographic and clinical characteristics including cancer type , presence of bone metastases , baseline pain severity , neuropathic and nociceptive pain , and depressive state , were well balanced between the three treatment groups . The main analysis of the study was on the VAS scores at visit 2 ( day 4 ) . The mean VAS values for both associations imipramine plus diclofenac and codeine plus diclofenac were similar to the association placebo plus diclofenac . Patients on imipramine plus diclofenac and on placebo plus diclofenac were withdrawn mainly for inadequate efficacy , while patients on codeine plus diclofenac discontinued equally for inadequate efficacy or adverse events . In conclusion , in a short‐term evaluation the addition of a tricyclic anti‐depressant or a weak opioid to diclofenac did not provide further analgesia with respect to diclofenac administration alone In a controlled double blind study of analgesics for the pain of gastrointestinal cancer , aspirin ( 650 mg ) was significantly more effective than placebo and superior to orally used codeine sulfate ( 60 mg ) . The effectiveness of aspirin was not specific for carcinoma of the pancreas , however , because the same pattern of pain relief was found in colonic carcinoma BACKGROUND Guidelines for cancer pain management include nonsteroidal antiinflammatory drugs with opioids administered in a time-contingent manner . This study was design ed to evaluate the role of oral ketamine or transdermal nitroglycerin polymer , a nitric oxide donor , as coadjuvants to oral morphine in cancer pain therapy . METHODS After institutional approval and informed patient consent were obtained , 60 patients with cancer pain were r and omized to one of four groups ( n = 15 ) and studied prospect ively to evaluate analgesia and any adverse effects . A visual analog scale that consisted of a 10-cm line with 0 representing " no pain at all " and 10 representing " the worst possible pain " was introduced . All patients were regularly taking oral amitriptyline 50 mg at bedtime . The morphine regimen was adjusted individually to a maximal oral dose of 80 - 90 mg/day to keep the visual analog scale score less than 4 . When patients reported pain ( visual analog scale of 4 or more ) , despite taking 80 - 90 mg oral morphine daily , the test drug was added as follows : the control group ( CG ) received an additional 20 mg oral morphine ( 10 mg at 12-h intervals ) ; the nitroglycerin group ( NG ) received a 5-mg nitroglycerin patch daily ; the ketamine group ( KG ) received 0.5 mg/kg oral ketamine at 12-h intervals ; and the dipyrone group ( DG ) received 500 mg oral dipyrone at 6-h intervals . Patients were free to manipulate their daily morphine consumption when the test drug was introduced to keep their visual analog scale score less than 4 . RESULTS The groups were similar with respect to demographic data and visual analog scale pain scores before treatment . The visual analog scale scores after the test drug was introduced were similar among the groups . The daily consumption of oral morphine was as follows : on day 15 : CG = DG = NG ( P > 0.05 ) , CG > KG ( P = 0.036 ) ; on day 20 : CG > NG = KG ( P < 0.02 ) ( CG > KG , P < 0.005 ; CG > NG , P < 0.02 ) , DG > KG ( P < 0.05 ) ; on day 30 : CG = DG > KG = NG ( P < 0.05 ) . Patients in the CG and DG groups reported somnolence , but patients in the NG and KG groups did not . CONCLUSIONS Low-dose ketamine and transdermal nitroglycerin were effective coadjuvant analgesics . In conjunction with their opioid tolerance-sparing function , joint delivery of ketamine or nitric oxide donors with opiates may be of significant benefit in cancer pain management Introduction Adjunct nonopioid analgesics may improve pain control in patients with cancer needing morphine or its derivates . Dypirone is a cheap nonopioid analgesic widely used in many countries . Objective The objective of the study was to evaluate , whenever morphine was started , if associating dipyrone with it would improve pain control and if this effect was time dependent . Material s and methods This is a double-blind placebo-controlled r and omized crossover study . Thirty-four ambulatory cancer patients experiencing cancer-related pain for which oral morphine was to be started at the dose of 10 mg orally ( PO ) every 4 h were r and omized to take either dipyrone 500 mg PO every 6 h or placebo . After 48 h , patients would be switched from dipyrone to placebo and vice versa . Pain was the primary outcome and was measured using a visual analogue scale before starting medications , at 48 and 96 h. Results We r and omized 16 patients to start with placebo ( group 1 ) and 18 with dipyrone ( group 2 ) . Pain scores for groups 1 and 2 were at baseline : 7.31 ± 0.29 vs 6.88 ± 0.28 ( p = 0.3 ) , at 48 h : 7.06 ± 0.32 vs 5.5 ± 0.31 ( p = 0.001 ) , and at 96 h : 3.18 ± 0.39 vs 1.94 ± 0.37 ( p = 0.03 ) . Both groups had significant improvements in pain scores after introducing dipyrone ( p < 0.001 , for both ) . Main toxicities were nausea , vomiting , epigastric pain , and myalgias . Twenty-eight patients chose dipyrone , four placebo , and two were indifferent . Conclusions We conclude that dipyrone adds significantly to the analgesic effect of morphine and , when given at the time of starting morphine , results in better pain scores even after dipyrone is discontinued Summary The analgesic efficacy and tolerability of nimesulide and naproxen were compared in 68 patients with advanced cancer who needed to be treated with nonsteroidal anti-inflammatory drugs according to the first step of the pharmacological analgesic scale of the WHO . Patients received either nimesulide 200 mg or naproxen 500 mg twice daily . The analgesic efficacy and tolerability of the 2 drugs appeared to be similar . Both drugs were effective and were associated with a low incidence of adverse reactions BACKGROUND The European Pain in Cancer survey sought to increase underst and ing of cancer-related pain and treatment across Europe . PATIENTS AND METHODS Patients with all stages of cancer participated in a two-phase tele Output:

There is no high- quality evidence to support or refute the use of NSAIDs alone or in combination with opioids for the three steps of the three-step WHO cancer pain ladder . There is very low- quality evidence that some people with moderate or severe cancer pain can obtain substantial levels of benefit within one or two weeks

MS2_1shot598

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background —Pulmonary hypertension is a clinical ly useful predictor of death in patients with heart failure . Whether pulmonary hypertension has the same prognostic value among specific underlying causes of cardiomyopathy is unknown . Using a diverse cohort of cardiomyopathy patients , we tested the hypotheses that ( 1 ) elevated mean pulmonary arterial pressure is the most important hemodynamic predictor of death and ( 2 ) the prognostic value of mean pulmonary pressure varies among different cardiomyopathies . Methods and Results — Patients ( n=1134 ) with new cardiomyopathy were prospect ively assigned a specific diagnosis on the basis of clinical evaluation and endomyocardial biopsy . All patients underwent right heart catheterization at baseline and were followed for an average of 4.4 years . In multivariate Cox models that allowed for nonlinear relations between hemodynamics and death , mean systemic pressure ( mSP ) and mean pulmonary arterial pressure ( mPA ) emerged as the most important hemodynamic predictors of death . Moreover , there was a statistically significant positive interaction between mPA and the diagnosis of myocarditis . For each 5–mm Hg increase in baseline mSP , mortality rates decreased with relative hazard ( RH ) of 0.89 ( 0.86 to 0.92 ) . For a 5–mm Hg increase in baseline mPA , mortality rates increased in patients who did not carry the diagnosis of myocarditis with RH 1.23 ( 1.17 to 1.29 ) ; among patients with myocarditis , mortality rates increased substantially with RH of 1.85 ( 1.50 to 2.29;P < 0.001 for interaction ) . Conclusions —Baseline mPA is particularly important for stratifying risk in myocarditis . These findings suggest that secondary pulmonary hypertension may have different biological features in myocarditis and that patients with pulmonary hypertension and myocarditis should be targeted for aggressive medical therapy Prognosis studies are investigations of future events or the evaluation of associations between risk factors and health outcomes in population s of patients ( 1 ) . The results of such studies improve our underst and ing of the clinical course of a disease and assist clinicians in making informed decisions about how best to manage patients . Prognostic research also informs the design of intervention studies by helping define subgroups of patients who may benefit from a new treatment and by providing necessary information about the natural history of a disorder ( 2 ) . There has recently been a rapid increase in the use of systematic review methods to synthesize the evidence on research questions related to prognosis . It is essential that investigators conducting systematic review s thoroughly appraise the method ologic quality of included studies to be confident that a study 's design , conduct , analysis , and interpretation have adequately reduced the opportunity for bias ( 3 , 4 ) . Caution is warranted , however , because inclusion of method ologically weak studies can threaten the internal validity of a systematic review ( 4 ) . This follows abundant empirical evidence that inadequate attention to biases can cause invalid results and inferences ( 5 - 9 ) . However , there is limited consensus on how to appraise the quality of prognosis studies ( 1 ) . A useful framework to assess bias in such studies follows the basic principles of epidemiologic research ( 10 , 11 ) . We focus on 6 areas of potential bias : study participation , study attrition , prognostic factor measurement , confounding measurement and account , outcome measurement , and analysis . The main objectives of our review of review s are to describe methods used to assess the quality of prognosis studies and to describe how well current practice s assess potential biases . Our secondary objective is to develop recommendations to guide future quality appraisal , both within single studies of prognostic factors and within systematic review s of the evidence . We hope this work facilitates future discussion and research on biases in prognosis studies and systematic review s. Methods Literature Search and Study Selection We identified systematic review s of prognosis studies by search ing MEDLINE ( 1966 to October 2005 ) using the search strategy recommended by McKibbon and colleagues ( 12 ) . This strategy combines broad search terms for systematic review s ( systematic review .mp ; meta- analysis .mp ) and a sensitive search strategy for prognosis studies ( cohort , incidence , mortality , follow-up studies , prognos * , predict * , or course ) . We also search ed the reference lists of included review s and method ologic papers to identify other relevant publications . We restricted our search to English- language publications . One review er conducted the search and selected the studies . Systematic review s , defined as review s of published studies with a comprehensive search and systematic selection , were included if they assessed the method ologic quality of the included studies by using 1 or more explicit criteria . We excluded studies if they were meta-analyses of independent patient data only , if their primary goal was to investigate the effectiveness of an intervention or specific diagnostic or screening tests , or if they included studies that were not done on humans . Data Extraction and Synthesis Individual items included in the quality assessment of the systematic review s were recorded as they were reported in the publication ( that is , the information that would be available to readers and future review ers ) . We review ed journal Web sites and contacted the authors of the systematic review s for additional information when authors made such an offer in their original papers . When review s assessed different study design s by using different sets of quality items , we extracted only those items used to assess cohort studies . We constructed a comprehensive list of distinct items that the review s used to assess the quality of their included studies . The full text of each review was screened . All items used by the review authors to assess the quality of studies were extracted into a computerized spreadsheet by 1 review er . Two experienced review ers , a clinical epidemiologist and an epidemiologist , independently synthesized the quality items extracted from the prognosis review s to determine how well the systematic review s assessed potential biases . We did this in 3 steps : 1 ) identified distinct concepts or domains addressed by the quality items ; 2 ) grouped each extracted quality item into the appropriate domain or domains ; and 3 ) identified the domains necessary to assess potential biases in prognosis studies . We then used this information to assess how well the review s ' quality assessment included items from the domains necessary to assess potential biases . After completing each of the first 3 steps , the review ers met to attempt to reach a consensus . The consensus process involved each review er presenting his or her observations and results , followed by discussion and debate . A third review er was available in cases of persistent disagreement or uncertainty . In the first step , all domains addressed by the quality items were identified . The first review er iteratively and progressively defined the domains as items were extracted from the included review s. The second review er defined domains from a r and om list of all extracted quality items . Limited guidance was provided to the review ers so that their assessment s and definitions of domains would be independent . The review ers agreed on a final set of domains that adequately and completely defined all of the extracted items . In the second step , review ers independently grouped each extracted item into the appropriate domains . Review ers considered each extracted item by asking , What is each particular quality item addressing ? or What are the review 's authors getting at with the particular quality assessment item ? . Items were grouped into the domain or domains that best represented the concepts being addressed . For example , the extracted items at least 80 % of the group originally identified was located for follow-up and follow-up was sufficiently complete or does n't jeopardize validity were each independently classified by both review ers as assessing the domain completeness of follow-up adequate , whereas the extracted item quantification and description of all subjects lost to follow-up was classified as assessing the domain completeness of follow-up described . In the third step , we identified the domains necessary to assess potential biases . Each review er considered the ability of the identified domains to adequately address , at least in part , 1 of the following 6 potential biases : 1 ) study participation , 2 ) study attrition , 3 ) prognostic factor measurement , 4 ) confounding measurement and account , 5 ) outcome measurement , and 6 ) analysis . Domains were considered to adequately address part of the framework if information garnered from that domain would inform the assessment of potential bias . For example , both review ers judged that the identified domain study population represents source population or population of interest assessed potential bias in a prognosis study , whereas the domain research question definition did not , although the latter is an important consideration in assessing the inclusion of studies in a systematic review . Finally , on the basis of our previous ratings , we looked at whether each review included items from the domains necessary to assess the 6 potential biases . We calculated the frequency of systematic review s by assessing each potential bias and the number of review s that adequately assessed bias overall . From this systematic synthesis , we developed recommendations for improving quality appraisal in future systematic review s of prognosis studies . We used Microsoft Access and Excel 2002 ( Microsoft Corp. , Redmond , Washington ) for data management and SAS for Windows , version 9.1 ( SAS Institute , Inc. , Cary , North Carolina ) for descriptive statistics . Role of the Funding Sources The funding sources , the Canadian Institutes of Health Research , the Canadian Chiropractic Research Foundation , the Ontario Chiropractic Association , and the Ontario Ministry of Health and Long Term Care , did not have a role in the collection , analysis , or interpretation of the data or in the decision to su bmi t the manuscript for publication . Results We identified 1384 potentially relevant articles . Figure 1 shows a flow chart of studies that were included and excluded . Figure 2 shows the number of review s identified by year of publication . We excluded 131 systematic review s of prognosis studies that did not seem to include any quality assessment of the included studies ; this represented 44 % of prognosis review s. We included 163 review s of prognosis studies in our analysis ( 13 - 175 ) . The most common topics were cancer ( 15 % ) , musculoskeletal disorders and rheumatology ( 13 % ) , cardiovascular ( 10 % ) , neurology ( 10 % ) , and obstetrics ( 10 % ) . Other review s included a wide range of health and health care topics . Sixty-three percent of the review s investigated the association between a specific prognostic factor and a particular outcome ; the remainder investigated multiple prognostic factors or models . The number of primary studies included in each systematic review ranged from 3 to 167 ( median , 18 [ interquartile range , 12 to 31 ] ) . A complete description of the included review s is available from the authors on request . Figure 1 . Flow diagram of inclusion and exclusion criteria of systematic review s. Figure 2 . Number of systematic review s of prognosis studies identified over time . Quality Items One hundred fifty-three review s provided adequate detail to allow extraction of quality items . Eight hundred eighty-two distinct quality items were extracted from the review s. Most review s developed their own set of quality items , with only a few applying criteria from previous review s. Most quality items BACKGROUND Acute heart failure ( AHF ) in sub-Saharan Africa has not been well characterized . Therefore , we sought to describe the characteristics , treatment , and outcomes of patients admitted with AHF in sub-Saharan Africa . METHODS The Sub-Saharan Africa Survey of Heart Failure ( THESUS-HF ) was a prospect i ve , multicenter , observational survey of patients with AHF admitted to 12 university hospitals in 9 countries . Among patients presenting with AHF , we determined the causes , treatment , and outcomes during 6 months of follow-up . RESULTS From July 1 , 2007 , to June 30 , 2010 , we enrolled 1006 patients presenting with AHF . Mean ( SD ) age was 52.3 ( 18.3 ) years , 511 ( 50.8 % ) were women , and the predominant race was black African ( 984 of 999 [ 98.5 % ] ) . Mean ( SD ) left ventricular ejection fraction was 39.5 % ( 16.5 % ) . Heart failure was most commonly due to hypertension ( n = 453 [ 45.4 % ] ) and rheumatic heart disease ( n = 143 [ 14.3 % ] ) . Ischemic heart disease ( n = 77 [ 7.7 % ] ) was not a common cause of AHF . Concurrent renal dysfunction ( estimated glomerular filtration rate , < 30 mL/min/173 m(2 ) ) , diabetes mellitus , anemia ( hemoglobin level , < 10 g/dL ) , and atrial fibrillation were found in 73 ( 7.7 % ) , 114 ( 11.4 % ) , 147 ( 15.2 % ) , and 184 cases ( 18.3 % ) , respectively ; 65 of 500 patients undergoing testing ( 13.0 % ) were seropositive for the human immunodeficiency virus . The median hospital stay was 7 days ( interquartile range , 5 - 10 ) , with an in-hospital mortality of 4.2 % . Estimated 180-day mortality was 17.8 % ( 95 % CI , 15.4%-20.6 % ) . Most patients were treated with renin-angiotensin system blockers but not β-blockers at discharge . Hydralazine hydrochloride and nitrates were rarely used . CONCLUSIONS In African patients , AHF has a predominantly nonischemic cause , most commonly hypertension . The condition occurs in middle-aged adults , equally in men and women , and is associated with high mortality . The outcome is similar to that observed in non-African AHF registries , suggesting that AHF has a dire prognosis globally , regardless of the cause BACKGROUND Prognostic implication s of echocardiographic assessment of pulmonary hypertension ( PH ) in non-selected patients hospitalized for acute heart failure ( AHF ) are not clearly defined . The aim of this study was to evaluate the association between echocardiography-derived PH in AHF and 1-year all-cause mortality . METHODS We prospect ively included 1210 consecutive patients admitted for AHF . Patients with significant Output:

PH was consistently associated with increased mortality risk in all forms of LHD , except for aortic valve disease where findings were inconsistent . CONCLUSIONS PH is almost invariably associated with increased mortality risk in patients with LHD .

MS2_1shot599

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Prospect i ve memory ( PM ) , the act of remembering that something has to be done in the future without any explicit prompting to recall , provides a useful framework with which to examine problems in internal- source monitoring . This is because it requires distinguishing between two internally-generated processes , namely the intention to perform an action versus actual performance of the action . In habitual tasks , such as taking medicine every few hours , the same PM task is performed regularly and thus it is essential that the individual is able to distinguish thoughts ( i.e. , thinking about taking the medicine ) from actions ( i.e. , actually taking the medicine ) . Methods We assessed habitual PM in patients with schizophrenia by employing a laboratory analogue of a habitual PM task in which , concurrently with maneuvering a ball around an obstacle course ( ongoing activity ) , participants were to turn over a counter once during each trial ( PM task ) . After each trial , participants were asked whether they had remembered to turn the counter over . Results Patients with schizophrenia made a disproportionate number of errors compared to controls of reporting that a PM response had been made ( i.e. , the counter turned over ) after an omission error ( i.e. , the counter was not turned over ) . There was no group difference in terms of reporting that an omission error occurred ( i.e. , forgetting to turn over the counter ) when in fact a PM response had been made . Conclusion Patients with schizophrenia displayed a specific deficit distinguishing between two internally-generated sources , attributable to either poor source monitoring or temporal discrimination Working memory may be conceptualized as a multi-component system involving the active maintenance and manipulation of stored information in the service of planning/guiding behaviour . Impaired spatial working memory is a robust finding in schizophrenia patients which has been related to an impairment in frontostriatal connectivity . The purpose of this study was to examine the specificity of this impairment by comparing the mnemonic and executive aspects of working memory performance in schizophrenia and bipolar disorder with psychotic features , focusing particularly on the functional dynamics between task components . Twenty-four patients with schizophrenia , 14 patients with bipolar I disorder ( manic phase ) and 33 healthy control subjects were assessed using the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) : including the spatial working memory ( between search errors and strategy scores ) spatial span ( storage capacity ) and spatial planning ( Stockings of Cambridge : accuracy and latency ) tasks . Both patient groups were impaired on the spatial span task , which requires the maintenance and retrieval of stored information . In contrast , only schizophrenia patients showed a significant deficit in between search errors , which requires both maintenance and manipulation of information in working memory . That is , they exhibited both a mnemonic and an executive dysfunction . Spatial span was particularly important to accurate planning ability in bipolar patients . In contrast , in patients with schizophrenia poor spatial working memory was a significant predictor of planning impairments , consistent with failures in goal selection , evaluation and /or execution . Furthermore , initial planning time was positively correlated with the latency to complete a planning sequence . This pattern of slow cognitive processing in schizophrenia patients only , resembled that reported previously in patients with basal ganglia disorders . These findings are discussed in terms of a possible common disturbance in fronto-parietal circuitry in the two disorders together with a specific disturbance of fronto-striatal circuitry in schizophrenia , that is not present in bipolar disorder There is accumulating evidence for involvement of the prefrontal cortex ( PFC ) in the pathophysiology of schizophrenia . A primary function supported by the PFC is working memory ( WM ) . Findings from WM studies in schizophrenia can provide insight into the nature of clinical symptoms and cognitive deficits associated with this disorder , as well as begin to suggest areas of underlying neuropathology . To date , studies have not adequately investigated different WM domains ( e.g. , verbal , spatial , or object ) or processing requirements ( e.g. , maintenance , monitoring , or manipulation ) , shown to be associated with distinct patterns of neural activation , in schizophrenia patients and their well relatives . Accordingly , this study evaluated the performance of schizophrenia patients , their first-degree biological relatives , and nonpsychiatric controls on a comprehensive battery of WM tasks and investigated the association among WM deficits and schizophrenia-spectrum psychopathology . The findings indicate that schizophrenia patients are consistently impaired on WM tasks , irrespective of WM domain or processing requirements . In contrast , their unaffected relatives are only impaired on WM tasks with higher central executive processing requirements . This pattern of WM performance may further implicate DLPFC dysfunction in the liability for schizophrenia and has implication s for future cognitive , genetic , and neurodevelopmental research The purpose of this study was to investigate basal ganglia ( BG ) and medial temporal lobe ( MTL ) dependent learning in patients with schizophrenia . Acquired equivalence is a phenomenon in which prior training to treat two stimuli as equivalent ( if two stimuli are associated with the same response ) increases generalization between them . The learning of stimulus-response pairs is related to the BG , whereas the MTL system participates in stimulus generalization . Forty-three patients with DSM-IV schizophrenia and 28 matched healthy controls participated . Volunteers received the Rutgers acquired equivalence task ( face-fish task ) by [ Myers , C.E. , Shohamy , D. , Gluck , M.A. et al. , 2003 . Dissociating hippocampal versus basal ganglia contributions to learning and transfer . J. Cogn . Neurosci . 15 , 185 - 193 . ] , the California Verbal Learning Test ( CVLT ) , and the n-back working memory test . The Rutgers acquired equivalence task investigates BG-dependent processes ( stimulus-response learning ) and MTL-dependent processes ( stimulus generalization ) with a single test . Results revealed that patients with schizophrenia showed a selective deficit on stimulus generalization , whereas stimulus-response learning was spared . The stimulus generalization deficit correlated with the CVLT performance ( total scores from trials 1 - 5 and long-delay recall ) , but not with the n-back test performance . The number of errors during stimulus-response learning correlated with the daily chlorpromazine-equivalent dose of antipsychotics . In conclusion , this is the first study to show that patients with schizophrenia exhibit deficits during MTL-dependent learning , but not during BG-dependent learning within a single task . High-dose first generation antipsychotics may disrupt BG-dependent learning by blocking dopaminergic neurotransmission in the nigro-stiratal system Previous investigations have found that increasing circulating glucose availability can increase memory performance in rodents , healthy humans , and individuals with dementia of the Alzheimer 's type . In this study , patients with schizophrenia , healthy control subjects , and controls with bipolar affective disorder were tested using double-blind treatment with either 50 g anhydrous dextrose plus 4 mg sodium saccharin ( for " taste " ) or 23.7 mg saccharin alone , followed by cognitive testing on a complex battery . At this glucose dose , verbal memory performance on a paragraph recall task was increased during the glucose condition relative to the saccharin condition in the patients with schizophrenia ; this effect was not detected in either the psychiatric or normal controls . The results provide preliminary support for the hypothesis that memory performance can be improved in patients with schizophrenia by increasing circulating glucose availability and suggest the importance of further evaluation of therapeutic manipulations of glucose availability Controls ( N = 45 ) , schizophrenics ( N = 20 ) and alcoholics ( N = 23 ) were asked to choose at r and om a number between 1 and 10 , 100 times . The correlation matrices of five different r and omization indices were used to study within group variation ; these matrices were similar for the normal and alcoholic groups , but very different for the schizophrenic group . The differences between the three groups were studied by canonical analysis and , in terms of the canonical variables , the mean performance of the normal group is clearly discriminated from that of the alcoholic and schizophrenic subjects To characterize the deficit in r and om number generation in schizophrenia with respect to control of sensory information processing , the present study employed a r and om number generation task using 10 digits ( 0 to 9 ) and compared two response modes ( oral and written ) with different amounts of sensory availability about the previous choices of the subject . Analysis indicated that the increased availability of previous information in the written response mode may exacerbate an aspect of the deficit in r and om number generation in schizophrenia reflecting the disturbance in control of sensory information processing . The comparison of performance in written and oral response modes may be useful in assessing schizophrenic psychopathology Patients with first-episode ( FE ) schizophrenia ( n=40 ) , with chronic schizophrenia ( n=40 ) and healthy controls ( n=40 ) matched for age , gender , education and parental socioeconomic status were administered a battery of st and ardized neuropsychological ( NP ) tests . Both patient groups showed generalized impairment relative to controls and the most pronounced deficits in visual-motor processing and attention ( VSM ) . Compared with FE patients , chronic schizophrenics performed worse in VSM and abstract ion/flexibility . Our findings suggest that NP deficits are fundamental manifestations of the illness , and that mainly frontally based dysfunctions are more prominent in chronic , kraepelinian patients The functioning of working memory in schizophrenic patients according to Baddeley 's model was examined in two complementary experiments . Experiment 1 comprised 27 patients and their controls , matched in age and level of education . Of this pool , 20 pairs participated also in Experiment 2 . Digit span , reading rate , and immediate serial recall assessed the functioning of the phonological loop . Corsi and pattern span tasks assessed the capacity of visuo-spatial memory . The central executive 's ability to monitor two concurrent tasks was evaluated in a dual task paradigm , and its capacity to control action in a r and om generation task . A preliminary set of analyses showed that the patients ' performances were reduced in all tasks explored , except in digit span . This initial pattern changed consistently after controlling for reading rate . While slow and fast reading patients were comparable in demographic and clinical criteria , slow reading patients showed impaired performance in all tasks , whereas fast reading patients exhibited reduced performance in visuo-spatial tasks and in the r and om generation task only . The state of functioning of working memory in schizophrenia appears , therefore , to vary consistently among the components of the model and is markedly impaired in slow reading patients . The implication s of slowness are discussed Objective : Atypical neuroleptics seem to be more beneficial than typical ones with respect to long-term neuropsychological functioning . Thus , most studies focus on the long-term effects of neuroleptics . We were interested in whether atypical neuroleptic treatment is also superior to typical drugs over relatively short periods of time . Methods : We studied 20 schizophrenic patients [ 10 males , mean age 35.5 years , mean Brief Psychiatric Rating Scale ( BPRS ) score at entry 58.9 ] admitted to our hospital with acute psychotic exacerbation . Nine of them were treated with typical and 11 with atypical neuroleptics . In addition , 14 healthy drug-free subjects ( 6 males , mean age 31.2 years ) were enrolled in the study and compared to the patients . As neuropsychological tools , a divided attention test , the Vienna reaction time test , the Benton visual retention test , digit span and a Multiple Choice Word Fluency Test ( MWT-B ) were used during the first week after admission , within the third week and before discharge ( approximately 3 months ) . Results : Patients scored significantly worse than healthy controls on nearly all tests ( except Vienna reaction time ) . Clinical ratings [ BPRS and Positive and Negative Symptom Scale for Schizophrenia ( PANSS ) ] improved markedly ( p < 0.01 ) , without a significant difference between typical and atypical medication . Clinical improvement ( PANSS total score ) correlated with less mistakes on the Benton test ( r = 0.762 , p = 0.017 ) and an improvement on the divided attention task ( r = 0.705 , p = 0.034 ) . Neuropsychological functioning ( explicit memory , p < 0.01 ; divided attention , p < 0.05 ) moderately improved for both groups under treatment but without a significant difference between atypical and typical antipsychotic drugs . Conclusions : Over short periods of time ( 3 months ) , neuropsychological disturbances in schizophrenia seem to be moderately responsive to both typical and atypical neuroleptics Twenty-six patients with schizophrenia and 12 patients with schizophrenia-like psychosis of epilepsy ( SLPE ) were compared to 38 healthy volunteers and 12 nonpsychotic patients with epilepsy to determine the contribution of psychosis to the pattern of cognition . Tests of memory and executive function were used . The schizophrenic group was more cognitively impaired than the SLPE and comparison groups . The profile of neuropsychological impairment in SLPE resembled that of schizophrenia and is unlikely to be explained solely by temporal lobe dysfunction . These results do not support the concept of SLPE as an independent nosological entity BACKGROUND The role of the inhibitory neurotransmitter gamma aminobutyric acid ( GABA ) in schizophrenia has previously been investigated using postmortem material . Recently , using single photon emission tomography ( SPET ) with the selective benzodiazepine antagonist 123I-Iomazenil as the radiolig and , we have demonstrated an in vivo relationship between reduced GABAA/benzodiazepine receptor binding and the severity of positive symptomatology in schizophrenia . The present study aim ed to build on this using the same in vivo scanning techniques , and relating findings to cognitive functioning . METHO Output:

RESULTS Statistically significant effect sizes were found for all working memory measures , indicating deficits in schizophrenia groups . Meta-regression analyses showed that the working memory deficit was not simply explained by discrepancies in current IQ between schizophrenia and control groups . CONCLUSIONS Large deficits in working memory were demonstrated in schizophrenia groups across all three working memory domains . There were , however , no clear differences across subdomains or between particular working memory tasks .