Methods to identify the target population: implications for prescribing quality indicators

Background  

Information on prescribing quality is increasingly used by policy makers, insurance companies and health care providers. For reliable assessment of prescribing quality it is important to correctly identify the patients eligible for recommended treatment. Often either diagnostic codes or clinical measurements are used to identify such patients. We compared these two approaches regarding the outcome of the prescribing quality assessment and their ability to identify treated and undertreated patients.     

Life events involvement in psoriasis onset/recurrence

Background The purpose of the study was to evaluate the possible role of stress before the onset/extension/recurrence of psoriasis. Patients and method One hundred and sixty‐nine outpatients with psoriasis and 169 age and gender matched controls were enrolled. The design was a case‐control study (controls had skin diseases with low psychosomatic component). Stressful life events were evaluated using Holmes and Rahe’s Social Readjustment Rating Scale. Results In the psoriatic group, there was a female predominance (66%) and a median age 47.55 years (SD = 20.32). In all, 10.65% of patients had family history of psoriasis. More than 54% of cases experienced at least one stressful event (47.36% for onset, 63.51% for recurrence/extension), compared with 19.52% of controls (χ² = 42.71, P < 0.0001). The odds ratio was 4.92. There was a significant difference in the mean number of stressful events between patients and controls (P < 0.0001). Women with psoriasis vulgaris and men with guttate psoriasis seemed to be more sensitive to stressful events. We divided the events described by Holmes and Rahe into three categories: family, personal, and job/financial problems. Family matters were mentioned by 42.7% of psoriatic patients, statistically significant compared with controls (P < 0.0001). In 35% of psoriatic cases, “the stressful event” was represented by the illness/death of someone dear. Both “personal” (25.6%; P = 0.02) and “job/financial problems” (31.6%; P < 0.0001) were significantly different compared with controls. Conclusions Stressful events could be highly related to psoriasis (especially in recurrences/extensions). Problems related to family are the most often involved with counseling being suggested.     

Is osteopathic manipulative treatment effective in migraine?

BackgroundMigraine is a common disorder with a prevalence in the population of 6% in men and 18% in women. Recent studies documented controversial results in relation to the benefit of the application of OMT in migraine and those are even more unclear if CAM are considered. The aim of the present study was to determine the efficacy of the OMT on a sample of subjects affected by migraine evaluated using the HIT-6 questionnaire.MethodsThe study was carried out in the Department of Neurology of Ancona's United Hospitals in the period between March and November 2010. All patients admitted in the unit with a diagnosis of migraine, according with International Headache Society criteria, were considered eligible for the study. Patients with secondary forms of headache, chronic illness, psychiatric illness, post-menopausal women, aged under 18 and over 50 years old were excluded from the study. According to the sample size calculation using an effect size of 5 points between groups and 27 within groups with a power of 90% and an alpha equal to 0.05, 105 patients entered in the study and were randomly divided in three groups (N = 35 in each group): OMT only, drugs (triptans) only and sham therapy. All patients were followed up for 6 months. Questionnaires were used to evaluate both the severity of migraine (HIT-6), considered as primary outcome, and the quality of life (SF-36v2), secondary outcome. Socio-demographic data were collected as well. One-way ANOVA was used to test the difference in variance among the three groups having defined a level of significant less than 0.05.ResultsAt baseline, no differences between the three groups in term of socio-demographic characteristics, severity of migraine and quality of life. At the end of the follow-up ANOVA showed a statistically significant difference on the primary outcome between the three groups F(2, 29) = 7.01; p = 0.003. Tukey post-hoc comparisons of the three groups indicate that sham group was not statistically different from drug group (M = ?4.25; 95% CI: ?11.80, 3.30; p = 0.36), whilst OMT group was statistically different from drug group (M = ?11.70; 95% CI: ?19.72, ?3.69; p = 0.003); and from sham group (M = ?7.45; 95% CI: ?14.30, ?0.61; p = 0.03).ResultsThe present study showed a significant difference between OMT group compared to drug and sham therapy groups, suggesting that OMT can be considered a valid procedure for the management of patients with migraine.     

A neuropsychological study comparing patients infected with HCV and HBV without psychiatric comorbidities

Hepatitis C is one of the most common chronic infectious diseases worldwide, with well‐documented extra‐hepatic manifestations, such as a broad number of cognitive deficits. These impairments may be explained by psychiatric comorbidities, which have not been investigated properly in the literature. In order to elucidate a specific hepatitis C virus (HCV) induced cognitive impairment not related to mental disorders, neuropsychological performance of patients infected with HCV was compared with that of patients infected with hepatitis B virus cognitive impairment, especially psychiatric comorbidities. A total of 33 patients infected with HCV and 22 patients infected with HBV were included in the study. There were no significant differences between the two groups with regard to age or years of education. The group of patients infected with HCV performed significantly worse on visuo‐spatial memory tasks after adjusting for years of education and age. There were no significant differences between patients infected with HCV and patients infected with HBV with regards to other neuropsychological functions. The data indicate that patients infected with HCV patients have poorer visuo‐spacial memory performance than patients infected with HBV, suggesting that the cognitive deficit may be specific to HCV infection and not to secondary comorbid psychiatric disorders. J. Med. Virol. 81:1184–1188, 2009. © 2009 Wiley‐Liss, Inc.     

Synchronous Rectal and Hepatic Resection of Rectal Metastatic Disease

Background  

The objectives were to determine the feasibility of combined rectal and hepatic resections and analyze the disease-free survival and overall survival.     

Automated 3D mapping of hippocampal atrophy and its clinical correlates in 400 subjects with Alzheimer's disease,mild cognitive impairment,and elderly controls

We used a new method we developed for automated hippocampal segmentation, called the auto context model, to analyze brain MRI scans of 400 subjects from the Alzheimer's disease neuroimaging initiative. After training the classifier on 21 hand‐labeled expert segmentations, we created binary maps of the hippocampus for three age‐ and sex‐matched groups: 100 subjects with Alzheimer's disease (AD), 200 with mild cognitive impairment (MCI) and 100 elderly controls (mean age: 75.84; SD: 6.64). Hippocampal traces were converted to parametric surface meshes and a radial atrophy mapping technique was used to compute average surface models and local statistics of atrophy. Surface‐based statistical maps visualized links between regional atrophy and diagnosis (MCI versus controls: P = 0.008; MCI versus AD: P = 0.001), mini‐mental state exam (MMSE) scores, and global and sum‐of‐boxes clinical dementia rating scores (CDR; all P < 0.0001, corrected). Right but not left hippocampal atrophy was associated with geriatric depression scores (P = 0.004, corrected); hippocampal atrophy was not associated with subsequent decline in MMSE and CDR scores, educational level, ApoE genotype, systolic or diastolic blood pressure measures, or homocysteine. We gradually reduced sample sizes and used false discovery rate curves to examine the method's power to detect associations with diagnosis and cognition in smaller samples. Forty subjects were sufficient to discriminate AD from normal and correlate atrophy with CDR scores; 104, 200, and 304 subjects, respectively, were required to correlate MMSE with atrophy, to distinguish MCI from normal, and MCI from AD. Hum Brain Mapp 2009. © 2009 Wiley‐Liss, Inc.     

Functional imaging of emotional memory in bipolar disorder and schizophrenia

Objectives: Although in current diagnostic criteria there exists a distinction between bipolar disorder and schizophrenia, many patients manifest features of both disorders, and it is unclear which aspects, if any, confer diagnostic specificity. In the present study, we investigate whether there are differences in medial temporal lobe (MTL) activation in bipolar disorder and schizophrenia. We also investigate associations between activation levels and symptom severity across the disorders. Methods: Functional magnetic resonance imaging scans were conducted on 14 healthy controls, 14 patients with bipolar disorder, and 15 patients with schizophrenia undergoing an emotional memory paradigm. Results: All groups demonstrated the expected pattern of behavioural responses during encoding and retrieval, and there were no significant group differences in performance. Robust MTL activation was seen in all three groups during viewing of emotional scenes, which correlated significantly with recognition memory for emotional stimuli. The bipolar group demonstrated relatively greater increases in activation for emotional versus neutral scenes in the left hippocampus than both controls and patients with schizophrenia. There was a significant positive correlation between mania scores and activation in the anterior cingulate, and a significant negative correlation between depression scores and activation in the dorsolateral prefrontal cortex. Conclusion: These results provide evidence that there are distinct patterns of activation in the MTL during an emotional memory task in bipolar disorder and schizophrenia. They also demonstrate that different mood states are associated with different neurobiological responses to emotion across the patient groups.