Reward and Punishment Sensitivity and Emotion Regulation Processes Differentiate Bipolar and Unipolar Depression

Bipolar disorder (BD) and major depressive disorder (MDD) cannot be reliably differentiated by depression symptom expression alone, suggesting a need to identify processes that may more effectively differentiate the two disorders. To explore this question, currently depressed adults with BD (n?=?30) and MDD (n?=?30), and healthy control participants with no history of psychiatric illness (CTL; n?=?30), completed self-report measures of reward and punishment sensitivity (i.e., behavioral activation and inhibition) and emotion regulation processes (i.e., rumination and avoidance). Results revealed that constructs putatively linked to depression across the mood disorders (i.e., behavioral inhibition, negative rumination, dampening of positive affect, behavioral and experiential avoidance) were significantly higher in both mood disorder groups compared to CTLs. Yet there was also some specificity between mood disorder groups, such that the BD group reported significantly greater reward responsiveness and positive rumination, in addition to greater behavioral inhibition and avoidance, compared to the MDD group. These data suggest that patterns of affective responding previously linked to underlying risk for mania in BD may remain evident during a major depressive episode. Further, current models of reward sensitivity in BD may benefit from the inclusion of punishment sensitivity and behavioral avoidance, particularly with respect to bipolar depression.     

Remoteness and Valence of Autobiographical Memory in Depression

We examined whether major depressive disorder (MDD) is associated with a tendency to recall more remote, specific autobiographical memories, particularly in the context of positive memories. To this end, individuals with MDD (n?=?26) and healthy controls (n?=?54) completed the Autobiographical Memory Test. Consistent with the hypothesis, remoteness of specific memories in the MDD group, but not the control group, depended on valence. Compared to the control group, the MDD group recalled more remote positive events. Additionally, the MDD group’s positive specific memories were significantly more remote than their negative specific memories. Retrieving remote positive memories might impair mood regulation and maintain an individual’s negative mood and perpetuate depression.     

Feeling Without Thinking? Anger Provocation Task Predicts Impaired Cognitive Performance in Bipolar Disorder but not Major Depression or Healthy Adults

Elevated anger and impairments in executive functioning are prominent features of bipolar disorder (BD). Given that anger has been found to interfere with some aspects of cognition in healthy individuals, it is possible that heightened anger could compromise cognitive processing even more substantially among individuals with BD. Despite the important clinical and psychosocial implications of such an effect, the precise consequences of anger for cognition in BD are not well understood. To address this, the present study employed a validated anger provocation task and examined its impact on performance of an arithmetic task, assessing both accuracy (number of correct responses) and task engagement (number of responses made) among adults with remitted bipolar I disorder (BD; n = 27), healthy non-psychiatric controls (CTL; n = 29), and a clinical control group of adults with remitted depression (MDD; n = 29). Results revealed that individuals with BD uniquely declined in the number of responses made across the task. In addition, self-reported anger was predictive of reduced task performance among individuals with BD. These results suggest that elevated anger may add to existing executive impairments in BD, compromising these individuals’ ability to remain engaged in cognitively demanding tasks in the context of anger.     

Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial

Purpose

This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy.

Methods

The randomised controlled trial compared a self-managed, home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy. Outcome measures included changes in self-report measures of anxiety, depression, fatigue, self-esteem, mood and physical activity. Fifty participants were randomised to either the intervention group (n?=?25), who received 12 weeks of moderate intensity walking, or the control group (n?=?25) mid-way through chemotherapy. Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration, intensity and exertion of their walking. Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups.

Results

The intervention had positive effects on fatigue (F?=?5.77, p?=?0.02), self-esteem (F?=?8.93, p?≤?0.001), mood (F?=?4.73, p?=?0.03) and levels of physical activity (x ²?=?17.15, p?=?0.0011) but not anxiety (F?=?0.90, p?=?0.35) and depression (F?=?0.26, p?=?0.60) as assessed using the HADS. We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs.

Conclusion

This self-managed, home-based intervention was beneficial for improving psychosocial well-being and levels of physical activity among breast cancer patients treated with chemotherapy.

Trial registration

Current Controlled Trials ISRCTN50709297.

     

The Impact of a Single Nucleotide Polymorphism in<Emphasis Type="Italic"> SIGMAR1</Emphasis> on Depressive Symptoms in Major Depressive Disorder and Bipolar Disorder

Introduction

Ample evidence suggested a role of sigma-1 receptor in affective disorders since the interaction of numerous antidepressants with sigma receptors was discovered. A recent study on Japanese subjects found a genetic variant within the encoding gene SIGMAR1 (rs1800866A>C) associated with major depressive disorder (MDD). We aimed to evaluate the same polymorphism in both MDD and bipolar disorder (BD) as well as its relationship to response to treatment with antidepressants and mood stabilizers.

Methods

A total of 238 MDD patients treated for an acute episode of depression, 132 BD patients in treatment with mood stabilizers for a manic or mixed episode, and 324 controls were genotyped for rs1800866. At discharge, response to treatments was evaluated in MDD and BD patients by the Hamilton Rating Scale for Depression (HRSD) and the Young Mania Rating Score (YMRS), respectively.

Results

In our Korean sample, allele frequencies were different from those reported in other Asian and non-Asian populations. The CC genotype was associated with BD and, as a trend, with MDD. No significant effect was observed on response to antidepressants in MDD or mood stabilizers in BD, although the CC genotype was more frequent among BD patients experiencing a mixed episode.

Conclusion

The present findings are the first to propose the putative role of genetic variants within SIGMAR1 and sigma-1 receptor in BD. Sigma-1 receptor can modulate a number of central neurotransmitter systems as well as some other signaling pathways (e.g., neurotrophin and growth factor signaling) which are seemingly involved in BD and other mood disorders.

     

Development of the Demotivating Beliefs Inventory and Test of the Cognitive Triad of Amotivation

Recent cognitive models of negative symptoms in psychosis posit that amotivation relevant beliefs are reflected in the cognitive triad of negative beliefs concerning the self, others and the future. The aim of this study was to test the proposed three-factor structure of putative ‘demotivating beliefs’ and to ascertain the strength of their association with self-reported amotivation. We combined existing scales assessing ‘demotivating beliefs’ to the Demotivating Beliefs Inventory. This scale was used for exploratory and confirmatory factor analyses as well as latent regression analyses with amotivation in two independent community (n₁?=?98; n₂?=?347) and one clinical sample (n?=?36). We found a three-factor structure with satisfying model fit (‘selfdefeating beliefs’, ‘social indifference beliefs’ and ‘low-expectancy-of-pleasure beliefs’). Each factor showed moderate associations with amotivation (β-coefficients from 0.34 to 0.43; R²?=?.30). Our results support the validity of the cognitive triad and its benefit as a framework to analyze demotivating beliefs.     

Assessment of right ventricular longitudinal strain by 2D speckle tracking imaging compared with RV function and hemodynamics in pulmonary hypertension

The right ventricular longitudinal strain (RVLS) of pulmonary hypertension (PH) patients and its relationship with RV function parameters measured by echocardiography and hemodynamic parameters measured by right heart catheterization was investigated. According to the WHO functional class (FC), 66 PH patients were divided into FC I/II (group 1) and III/IV (group 2). RV function parameters were measured by echocardiographic examinations. Hemodynamic parameters were obtained by right heart catheterization. Patients in group 2 had higher systolic pulmonary artery pressure (sPAP; P?<?0.05) than patients in group (1) significant between-group differences were observed in global RVLS (RVLS_global), free wall RVLS (RVLS_FW; P?<?0.01), and RV conventional function parameters (all P?<?0.05). Moreover, mPAP and PVR increased remarkably and CI decreased significantly in group (2) RVLS_global had a positive correlation with 6-min walking distance (6MWD; r?=?0.492, P?<?0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP; r?=?0.632, P?<?0.001), while RVLS_FW had a positive correlation with 6MWD (r?=?0.483, P?<?0.001) and NT-proBNP (r?=?0.627, P?<?0.001). Hemodynamics analysis revealed that RVLS_global had a positive correlation with mPAP (r?=?0.594, P?<?0.001), PVR (r?=?0.573, P?<?0.001) and CI (r?=?0.366, P?=?0.003), while RVLS_FW had a positive correlation with mPAP (r?=?0.597, P?<?0.001), PVR (r?=?0.577, P?<?0.001) and CI (r?=?0.369, P?=?0.002). According to receiver operating characteristic curves, the optimal cut-off values of RVLS_global (–15.0%) and RVLS_FW (–15.3%) for prognosis detection with good sensitivity and specificity. Evidence has shown that RVLS measurement can provide the much-needed and reliable information on RV function and hemodynamics. Therefore, this qualifies as a patient-friendly approach for the clinical management of PH patients.     

On the use of approximate entropy and sample entropy with centre of pressure time-series

Background

Approximate entropy (ApEn) and sample entropy (SampEn) have been previously used to quantify the regularity in centre of pressure (COP) time-series in different experimental groups and/or conditions. ApEn and SampEn are very sensitive to their input parameters: m (subseries length), r (tolerance) and N (data length). Yet, the effects of changing those parameters have been scarcely investigated in the analysis of COP time-series. This study aimed to investigate the effects of changing parameters m, r and N on ApEn and SampEn values in COP time-series, as well as the ability of these entropy measures to discriminate between groups.

Methods

A public dataset of COP time-series was used. ApEn and SampEn were calculated for m?=?{2, 3, 4, 5}, r?=?{0.1, 0.15, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5} and N?=?{600, 1200} (30 and 60?s, respectively). Subjects were stratified in young adults (age?<?60, n?=?85), and older adults (age?≥?60) with (n?=?18) and without (n?=?56) falls in the last year. The effects of changing parameters m, r and N on ApEn and SampEn were investigated with a three-way ANOVA. The ability of ApEn and SampEn to discriminate between groups was investigated with a mixed ANOVA (within-subject factors: m, r and N; between-subject factor: group). Specific combinations of m, r and N producing significant differences between groups were identified using the Tukey’s honest significant difference procedure.

Results

A significant three-way interaction between m, r and N confirmed the sensitivity of ApEn and SampEn to the input parameters. SampEn showed a higher consistency and ability to discriminate between groups than ApEn. Significant differences between groups were mostly observed in longer (N?=?1200) COP time-series in the anterior-posterior direction. Those differences were observed for specific combinations of m and r, highlighting the importance of an adequate selection of input parameters.

Conclusions

Future studies should favour SampEn over ApEn and longer time-series (≥ 60?s) over shorter ones (e.g. 30?s). The use of parameter combinations such as SampEn (m?=?{4, 5}, r?=?{0.25, 0.3, 0.35}) is recommended.

     

Clinical Efficacy and Safety of Current Interventions for Choroidal Neovascularization Associated with Rare Diseases: A Systematic Literature Review

Introduction

The aim of this systematic literature review was to evaluate the efficacy and safety of interventions for the treatment of choroidal neovascularization (CNV) secondary to etiologies other than age-related macular degeneration and pathologic myopia.

Methods

Relevant randomized controlled trials (RCTs) and prospective observational studies were identified by searching MEDLINE, MEDLINE In-Process, EMBASE, and CENTRAL.

Results

The search identified 5 RCTs; no relevant observational studies were identified. The studies differed in terms of underlying cause of CNV, patient numbers (n?=?9–178), follow-up time (2–36 months) and quality assessment. In the largest RCT (n?=?178 across a range of rare CNV etiologies), intravitreal ranibizumab showed superior efficacy versus sham from baseline to month 2 [mean best-corrected visual acuity (BCVA): +?9.5 vs. ??0.4 letters; p?<?0.001]; the gain was maintained up to month 12. In the treatment of CNV secondary to presumed ocular histoplasmosis syndrome (POHS), both intravitreal ranibizumab and photodynamic therapy (PDT) showed significant improvement from baseline BCVA over the 12-month period (n?=?9); however, all patients in the PDT group required rescue ranibizumab therapy. Unlicensed intravitreal bevacizumab was associated with a statistically significant improvement in BCVA compared to PDT at 12 months (p?<?0.001) in patients with CNV secondary to multifocal choroiditis (n?=?27). The use of steroids before PDT showed better BCVA outcomes than PDT alone (p?<?0.05) in patients with idiopathic CNV (n?=?20). Argon green laser therapy showed limited efficacy in patients with CNV secondary to OHS (n?=?134).

Conclusion

There is evidence from a relatively large, good-quality study to support the use of intravitreal ranibizumab for the treatment of CNV secondary to rare diseases. However, the limited number of RCTs for this indication and differences in study characteristics between RCTs mean that there is uncertainty regarding comparative clinical effectiveness of interventions. RCTs with an active comparator are required to fully establish the comparative effectiveness of treatments for CNV secondary to rare diseases.

Funding

Novartis Pharmaceuticals UK Ltd, Surrey, UK.

     

The Hopelessness Theory of Depression: Clinical Utility and Generalizability

To date, “basic” research has dominated the empirical literature on hopelessness theory. The next logical step in this area of research is to determine if the theory can be used to help people. We conducted three studies to determine if the cognitive vulnerability factor featured in hopelessness theory could be reliably measured in diverse samples in a treatment context and if it could predict depressive therapeutic outcomes. Study 1 used a sample of male juvenile detainees (n?=?296; 70% from underrepresented groups) and found that cognitive vulnerability moderated the effectiveness of a social problem solving training intervention. Study 2 used a clinical sample of U.S. Veterans (n?=?16; 56% from underrepresented groups) enrolled in a cognitive behavioral therapy group for depression and found that cognitive vulnerability predicted post-therapy depressive outcomes. In both Study 1 and Study 2, higher levels of cognitive vulnerability resulted in poorer treatment outcomes (i.e., greater post-treatment levels of depressive symptoms). Study 3 used a clinical sample of U.S. Veterans (n?=?76; 67% from underrepresented groups) enrolled in a behavior activation group and found no effect of cognitive vulnerability on post-therapy depressive outcomes. The results of the three studies indicate that hopelessness theory’s cognitive vulnerability construct can be reliably measured in diverse samples in real world clinical contexts and that it has the potential to be a useful predictor of clinical outcomes in the context of cognitively focused treatments.     

Changes in Anxiety Sensitivity Following Group Cognitive-Behavior Therapy for Social Anxiety Disorder and Panic Disorder

The current study examined changes in anxiety sensitivity following cognitive behavior therapy as a predictor of treatment outcome in patients with social anxiety disorder (SAD) and patients with panic disorder (PD). One-hundred ninety-seven patients with a principal diagnosis of SAD (n = 108) or PD (n = 89) completed the Anxiety Sensitivity Index (ASI; Reiss et al in Behav Res Ther 24:1–8, 1986), Depression Anxiety Stress Scales (DASS-21; Lovibond and Lovibond in Behav Res Ther 33:335–343, 1995), Social Phobia Inventory (SPIN; Connor et al in Br J Psychiatry 176:379–386, 2000) and Panic Disorder Severity Scale-Self Report (PDSS-SR; Houck et al in Depress Anxiety 15:183–185, 2002; Shear et al in Am J Psychiatry 154:1571–1575, 1997) pre and post disorder specific treatment. For the SAD group, changes on ASI Physical and ASI Social subscales made significant contributions to the prediction of posttreatment social anxiety symptoms over and above pretreatment social anxiety symptoms and changes in depression scores. For the PD group, changes on the ASI Physical subscale made a significant contribution to the prediction of posttreatment panic symptoms over and above pretreatment panic symptoms and changes in depression scores. The present study provides further support that, while the global construct of anxiety sensitivity is a transdiagnostic factor across the anxiety disorders, the lower-order dimensions of anxiety sensitivity have specificity for particular anxiety disorders.     

Procalcitonin algorithm to guide initial antibiotic therapy in acute exacerbations of COPD admitted to the ICU: a randomized multicenter study

Purpose

To compare the efficacy of an antibiotic protocol guided by serum procalcitonin (PCT) with that of standard antibiotic therapy in severe acute exacerbations of COPD (AECOPDs) admitted to the intensive care unit (ICU).

Methods

We conducted a multicenter, randomized trial in France. Patients experiencing severe AECOPDs were assigned to groups whose antibiotic therapy was guided by (1) a 5-day PCT algorithm with predefined cutoff values for the initiation or stoppage of antibiotics (PCT group) or (2) standard guidelines (control group). The primary endpoint was 3-month mortality. The predefined noninferiority margin was 12%.

Results

A total of 302 patients were randomized into the PCT (n?=?151) and control (n?=?151) groups. Thirty patients (20%) in the PCT group and 21 patients (14%) in the control group died within 3 months of admission (adjusted difference, 6.6%; 90% CI ??0.3 to 13.5%). Among patients without antibiotic therapy at baseline (n?=?119), the use of PCT significantly increased 3-month mortality [19/61 (31%) vs. 7/58 (12%), p?=?0.015]. The in-ICU and in-hospital antibiotic exposure durations, were similar between the PCT and control group (5.2?±?6.5 days in the PCT group vs. 5.4?±?4.4 days in the control group, p?=?0.85 and 7.9?±?8 days in the PCT group vs. 7.7?±?5.7 days in the control group, p?=?0.75, respectively).

Conclusion

The PCT group failed to demonstrate non-inferiority with respect to 3-month mortality and failed to reduce in-ICU and in-hospital antibiotic exposure in AECOPDs admitted to the ICU.

     

Preoperative pain treatment in acute abdomen in Osogbo,Nigeria: a randomized double-blind placebo-controlled study

Background

Withholding analgesics in acute abdomen for fear of masking clinical features and impairing diagnosis and decision-making is still being practiced despite recent evidence to the contrary. This study assesses the effect of preoperative analgesia on clinical findings, clinical diagnosis, and decision-making in patients with non-trauma acute abdomen.

Method

This is a randomized, double-blind, placebo-controlled study using Tramal, a brand of tramadol, at the ED of LAUTECH Teaching Hospital Osogbo, Nigeria. Ninety-five patients between 18–60 years received Tramal (n?=?46) or placebo (n?=?49). The pain score, clinical findings, provisional diagnosis, and treatment plan were noted before and 15–20 min after administration of the analgesic or placebo. The final diagnosis arrived at after adequate investigation or operation was considered the gold standard. The pain scores, diagnosis, treatment plan, and decision between the two groups were compared. Statistical analysis was by SPSS 16. Results were considered statistically significant at p?<?0.05.

Results

Demography and case distribution were similar in both groups. The improvement in pain was greater in the Tramal group (p?=?0.001). The abdominal palpation findings were also better in the Tramal group (p?=?0.02). There were more changes in the diagnosis after use of Tramal (p?=?0.01). There were more changes in the decision in the Tramal group (p?=?0.03). Most of the changes in diagnosis and decision in the Tramal group were for the better.

Conclusion

The preoperative use of Tramal in acute abdomen improved the experience of pain and did not adversely affect the accuracy of the diagnosis or decision-making.

     

Dynamic changes in injured myocardium,very early after acute myocardial infarction,quantified using T1 mapping cardiovascular magnetic resonance

Background

It has recently been suggested that myocardial oedema follows a bimodal pattern early post ST-segment elevation myocardial infarction (STEMI). Yet, water content, quantified using tissue desiccation, did not return to normal values unlike oedema quantified by cardiovascular magnetic resonance (CMR) imaging. We studied the temporal changes in the extent and intensity of injured myocardium using T1-mapping technique within the first week after STEMI.

Methods

A first group (n?=?31) underwent 3 acute 3?T CMR scans (time-point (TP) <?3?h, 24?h and 6?days), including cine, native shortened modified look-locker inversion recovery T1 mapping, T2* mapping and late gadolinium enhancement (LGE). A second group (n?=?17) had a single scan at 24?h with an additional T2-weighted sequence to assess the difference in the extent of area-at-risk (AAR) compared to T1-mapping.

Results

The mean T1 relaxation time value within the AAR of the first group was reduced after 24?h (P?<?0.001 for TP1 vs.TP2) and subsequently increased at 6?days (P?=?0.041 for TP2 vs.TP3). However, the extent of AAR quantified using T1-mapping did not follow the same course, and no change was detected between TP1&TP2 (P?=?1.0) but was between TP2 &TP3 (P?=?0.019). In the second group, the extent of AAR was significantly larger on T1-mapping compared to T2-weighted (42?±?15% vs. 39?±?15%, P?=?0.025). No change in LGE was detected while microvascular obstruction and intra-myocardial haemorrhage peaked at different time points within the first week of reperfusion.

Conclusion

The intensity of oedema post-STEMI followed a bimodal pattern; while the extent of AAR did not track the same course. This discrepancy has implications for use of CMR in this context and may explain the previously reported disagreement between oedema quantified by imaging and tissue desiccation.

     

Hearing Impairment,Autism Spectrum Disorder,and Developmental Functioning in Infants and Toddlers

Autism spectrum disorder (ASD) tends to co-occur with other psychiatric disorders and medical conditions, and identification of comorbidities is crucial for appropriate intervention. Currently, little research has examined the relationship between ASD and deafness or hearing impairment (D/HI). The present study aimed to examine the effects of ASD and D/HI on autism symptomology as measured by the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), and developmental functioning in infants and toddlers as measured by the Battelle Developmental Inventory, Second Edition (BDI-2). Specific developmental domains were also investigated. This study compared children with atypical development (n = 24), comorbid atypical development and D/HI (n = 24), ASD only (n = 24), and comorbid ASD and D/HI (n = 24). The results indicated that an ASD diagnosis was a stronger indicator of ASD symptomology, overall developmental functioning, adaptive skills, personal-social skills, and communication skills than D/HI. However, the interaction between ASD and D/HI was more dynamic for the motor and cognitive domains. The results of the current study emphasize the importance of improved assessment techniques to identify both ASD and D/HI when they co-occur. Future research should be conducted to further elucidate the interaction of ASD and D/HI, as well as investigate these comorbidities in older samples.     

Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study

Background

Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation.

Methods

A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.

Results

Improved nursing documentation was found for 23 items (N?=?37), which was significant for nine items focusing mobility (p?=?0.002, p?=?0.024, p?=?0.012), pain (p?=?0.012), patient teaching (p?=?0.001, p?=?0.000) and discharge planning (p?=?0.000, p?=?0.002, p?=?0.004). Improved guideline use was found for 20 QIT-items (N?=?30), with significant improvement on six items focusing on mobility (p?=?0.023), depression (p?=?0.033, p?=?0.025, p?=?0.046, p?=?0.046), discharge planning (p?=?0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p?=?0.019) and Context (p?=?0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care.

Conclusion

Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.

     

Efficacy of Phonosurgery,Logopedic Voice Treatment and Vocal Pedagogy in Common Voice Problems of Singers

Introduction

Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM).

Methods

In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38?±?11 years (mean?±?SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic–aerodynamic analysis, and patients’ self-assessment (e.g., Singing Voice Handicap Index).

Results

While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n?=?25), nodules (n?=?9), and polyps (n?=?8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1?±?2.0 to 7.4?±?1.8 (p?<?0.001), and the VEM from 113?±?20 to 124?±?14 (p?<?0.001). Both parameters correlated significantly with each other (r_s?=?0.41). Phonosurgery had the largest impact on the improvement of vocal function. Conservative therapies provided smaller quantitative enhancements but also qualitative vocal restoration with recovered artistic capabilities.

Conclusions

Depending on individual medical indication, phonosurgery, logopedic treatment and voice teaching are all effective, objectively and subjectively satisfactory therapies to improve the impaired singing voice. The use of VEM in singers with functional and organic dysphonia objectifies and quantifies their vocal capacity as documented in the VRP. Complementing the established DSI, VEM introduction into practical objective voice diagnostics is appropriate and desirable especially for the treatment of singers.

     

Distinct Roles of Emotion Reactivity and Regulation in Depressive and Manic Symptoms Among Euthymic Patients

Investigating differences in the ways that people react to mood-evoking stimuli and regulate subsequent emotions may help to elucidate important mechanisms underlying depressed or hypomanic mood states. Euthymic young adults with bipolar disorder (n = 23) or depression (n = 21) were recruited for a study of emotion and mood. Two mood inductions assessed for differences in mood reactivity. Participants completed measures of current symptoms and emotion regulation strategies. Maladaptive (B = 0.42, p = .021) and adaptive (B = ?0.26, p = .011) emotion regulation strategies were significantly associated with depressive symptoms. Bipolar diagnosis (B = 5.51, p = .035), and threat mood reactivity (B = ?0.26, p = .015) were associated with hypomanic symptoms. Interaction terms for mood reactivity and emotion regulation were not significant in either model, although net regression indicated significant differences in two trends. Depressed moods, associated with MDD or BD, may be initiated and maintained primarily due to poor choice of emotion regulation strategies. Elevated mood states are more specific to bipolar disorder, and may be triggered by mood reactivity, rather than regulation.     

Acceleration of the learning curve for mastering basic critical care echocardiography using computerized simulation

Purpose

To assess the impact of computerized transthoracic echocardiography (TTE) simulation on the learning curve to achieve competency in basic critical care echocardiography (CCE).

Methods

In this prospective bicenter study, noncardiologist residents novice in ultrasound followed either a previously validated training program with adjunctive computerized simulation on a mannequin (two 3 h-sessions; Vimedix simulator, CAE Healthcare) (interventional group; n?=?12) or solely the same training program (control group; n?=?12). All trainees from the same institution were assigned to the same study group to avoid confusion bias. Each trainee was evaluated after 1 (M1), 3 (M3) and 6 (M6) months of training using our previously validated scoring system. Competency was defined by a score?≥?90% of the maximal value.

Results

The 24 trainees performed 965 TTE in patients with cardiopulmonary compromise during their 6-month rotation. Skills assessments relied on 156 TTE performed in 106 patients (mean age 53?±?14 years; mean Simplified Acute Physiologic Score 2: 55?±?19; 79% ventilated). When compared to the control group, trainees of the interventional group obtained a significantly higher mean skills assessment score at M1 (41.5?±?4.9 vs. 32.3?±?3.7: P?=?0.0004) and M3 (45.8?±?2.8 vs. 42.3?±?3.7: P?=?0.0223), but not at M6 (49.7?±?1.2 vs. 50.0?±?2.7: P?=?0.6410), due to higher practical and technical skills scores. Trainees of the control group required significantly more supervised TTE to obtain competency than their counterparts (36?±?7 vs. 30?±?9: p?=?0.0145).

Conclusions

Adjunctive computerized simulation accelerates the learning curve of basic CCE in improving practical and technical skills and reduces the number of TTE examinations required to reach competency.