Construct validity of the Mechanical Restraint – Confounders,Risk, Alliance Score (MR-CRAS): a new risk assessment instrument

Abstract

Background: A new short-term risk assessment instrument, the Mechanical Restraint – Confounders, Risk, Alliance Score (MR – CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists’ etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient’s readiness to be released from mechanical restraint.

Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions.

Materials and methods: MR – CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed.

Results: MR – CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25?hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR – CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient’s readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional.

Conclusions: The study shows evidence of the construct validity of MR – CRAS among clinicians at closed forensic mental health inpatient units. MR – CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint     

Deconstructing the ‘black box’ of the Camberwell assessment of need score in mental health services evaluation

OBJECTIVE: The aim of the study was to examine an alternative way of scoring the Camberwell Assessment of Need (CAN) for the purpose of service evaluation, using the by us defined Social Services (SI) and Psychiatric Services (PI) subindices. METHODS: CAN assessments in 1997 and 1999 of 262 outpatients (mean age 45 years, 77.1% psychotic disorders) were reanalysed to fit the SI and the PI, which were compared to the full CAN. RESULTS: The mean total needs on the full CAN decreased from 6.65 to 6.22 (P = 0.007), as did the mean unmet needs (1.55-1.81, P = 0.049). The mean total needs on the PI decreased from 2.42 to 2.22 (P = 0.006), as did the mean unmet needs (1.66-0.57, P < 0.001). No changes in mean needs occurred on the SI. CONCLUSIONS: All significant changes occurred on the PI, indicating a more beneficial outcome of the psychiatric care than the social care in terms of meeting needs, a result impossible to discern from the total scores of the CAN. Thus, output scores on subindices of the CAN might be useful as outcome measures in service evaluation.     

Dynamic testing in schizophrenia: does training change the construct validity of a test?

Dynamic testing typically involves specific interventions for a test to assess the extent to which test performance can be modified, beyond level of baseline (static) performance. This study used a dynamic version of the Wisconsin Card Sorting Test (WCST) that is based on cognitive remediation techniques within a test-training-test procedure. From results of previous studies with schizophrenia patients, we concluded that the dynamic and static versions of the WCST should have different construct validity. This hypothesis was tested by examining the patterns of correlations with measures of executive functioning, secondary verbal memory, and verbal intelligence. Results demonstrated a specific construct validity of WCST dynamic (i.e., posttest) scores as an index of problem solving (Tower of Hanoi) and secondary verbal memory and learning (Auditory Verbal Learning Test), whereas the impact of general verbal capacity and selective attention (Verbal IQ, Stroop Test) was reduced. It is concluded that the construct validity of the test changes with dynamic administration and that this difference helps to explain why the dynamic version of the WCST predicts functional outcome better than the static version.     

Quantitative assessment of the effect of FGF20 rs12720208 variant on the risk of Parkinson’s disease: a meta-analysis

Objectives: Many studies have investigated the association between fibroblast growth factor 20(FGF20) rs12720208(C/T) polymorphism and the susceptibility of Parkinson’s disease (PD). However, published data are still controversial. Here, we performed a meta-analysis to evaluate the association of rs12720208 polymorphism with the risk of PD.

Methods: Up to April 2016, Pubmed, EMbase, Web of science, the Chinese National Knowledge Infrastructure, and Wanfang Medicine were reviewed to identify appropriate documents. A total of seven papers involving 11 studies with 3360 PD cases and 3681 controls were included based on the strict inclusion and exclusion standards. And STATA 12.0 statistics software was used to calculate available data from each study. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated to assess the association between FGF20 rs12720208 polymorphism and PD risk.

Results: When all studies were pooled into this meta-analysis, neither the minor T allele frequencies nor the genotypic distributions were different between PD cases and controls. But the subgroup analysis stratified by ethnicity showed FGF20 rs12720208 polymorphism was associated with increased risk in the allele model (T vs. C:OR = 1.167, 95% CI = 1.020–1.335) and dominant model (TT + TC vs. CC:OR = 1.156, 95% CI = 1.001–1.335) in Caucasians but not in Asians.

Conclusions: This meta-analysis indicates that rs12720208 C/T variant might be associated with PD susceptibility in Caucasians.     

Do we need a new procedure for the assessment of adverse events in anti-migraine clinical trials?

The large number of randomized controlled clinical trials on migraine have drawn the attention of some authors to the need to improve the design of such trials. In particular, adequate methodology is a critical issue in their planning and execution, as different methodological approaches can translate into different results. The side-effects observed in both the active medication arm and the placebo arm--considering anti-migraine randomized clinical trials--are often influenced by non specific factors. This issue can be quantified by using a systematic review approach to study the rates of adverse events reported in the placebo arms of clinical trials. Such a study requires increased standardization of the methods used to collect adverse data in clinical trials. This focused review article provides a critical re-analysis of the results obtained, by our group, in a recent systematic review of adverse events reported in the placebo groups of clinical trials for three classes of anti-migraine drugs: NSAIDs, triptans and anticonvulsants [Amanzio et al., 2009]. We consider the need for caution in interpreting side-effect profiles of the different placebo groups. In particular, since the side-effects observed in both the active medication and placebo arms of randomized clinical trials are often influenced by patients' and investigators' expectations, the nocebo phenomenon may help to understand the occurrence of (adverse) non-specific side effects observed in these groups. We also discuss the importance of evaluating the role of contributing factors in the results obtained, such as the need for the examiner to be blind to the expected side-effects of the drug being evaluated and a better rationalization of informed consent in order to avoid the occurrence of negative expectations in patients, aimed at preventing negative expectation effects among both investigators and patients. Currently, there is one patented design for investigating reductions in the placebo effect in controlled clinical trials. This paper discusses how these ideas may be helpful in the assessment of adverse events in active and placebo groups.     

Impact of infection on risk of Parkinson’s disease: a quantitative assessment of case-control and cohort studies

Journal of NeuroVirology - Identifying modifiable risk factors for Parkinson’s disease (PD) to help prevent this disease has attracted increasing interest in recent years for the limited...     

Lowering the risk of Alzheimer’s disease: Evidence-based practices emerge from new research

BackgroundThe increasing prevalence of Alzheimer’s disease (AD) and other aging-related dementias as the population ages will have a dramatic impact on both provision of health care and the economy if nothing is done to prevent or delay the onset of AD or to slow its progression.MethodsA comprehensive review of the literature in several promising areas of inquiry, other than those representing Food and Drug Administration (FDA)–approved AD- or dementia-specific pharmacologic therapies, that may impact the risk or progression of AD and related dementias was undertaken.ResultsResults highlight a number of factors associated with AD and dementia. These include education and occupation, cognitive and leisure activities, exercise, cholesterol and statins, and head trauma.ConclusionsFactors associated with AD and dementia may have potential as strategies useful in preventing or delaying AD and dementia or slowing its progression. Further research is needed to determine the validity and strength of the associations and to ascertain causality.     

Pseudohallucinations: a pseudoconcept? A review of the validity of the concept, related to associate symptomatology

"Pseudohallucination" is a concept used in the classification of nonpsychotic perceptual disorders. This report describes the history of the concept and investigates whether pseudohallucinations can be differentiated from related psychopathological symptoms, such as hallucinations, re-experiencing, and dissociative phenomena. We performed a literature review, which shows that pseudohallucinations and related symptoms have low construct validity and are, accordingly, clinically ambiguous. Most likely, pseudohallucinations are placed on an overlapping continuum of symptomatology that includes perceptual disorders, re-experiencing, (dissociative) imagery, and normal thought and memory processes. Recommendations are made regarding the specification of dimensions of this continuum. The term "nonpsychotic hallucinations" is preferred over "pseudohallucination."     

Debate: COVID crisis,natural capital and clinical care – ‘building back better’ for a new values-based CAMHS

The COVID-19 pandemic has meant upheaval for child and adolescent mental health services and for children, young people and their families. We look at this disruption through the lens of values-based practice. We also briefly examine the concept of natural capital and the opportunity for ‘Building Back Better’ post-COVID. We suggest that as well as losses, there are also opportunities to rethink and reshape our practices to make them more value-based.     

Development and assessment of a composite score for memory in the Alzheimer’s Disease Neuroimaging Initiative (ADNI)

We sought to develop and evaluate a composite memory score from the neuropsychological battery used in the Alzheimer’s Disease (AD) Neuroimaging Initiative (ADNI). We used modern psychometric approaches to analyze longitudinal Rey Auditory Verbal Learning Test (RAVLT, 2 versions), AD Assessment Schedule - Cognition (ADAS-Cog, 3 versions), Mini-Mental State Examination (MMSE), and Logical Memory data to develop ADNI-Mem, a composite memory score. We compared RAVLT and ADAS-Cog versions, and compared ADNI-Mem to RAVLT recall sum scores, four ADAS-Cog-derived scores, the MMSE, and the Clinical Dementia Rating Sum of Boxes. We evaluated rates of decline in normal cognition, mild cognitive impairment (MCI), and AD, ability to predict conversion from MCI to AD, strength of association with selected imaging parameters, and ability to differentiate rates of decline between participants with and without AD cerebrospinal fluid (CSF) signatures. The second version of the RAVLT was harder than the first. The ADAS-Cog versions were of similar difficulty. ADNI-Mem was slightly better at detecting change than total RAVLT recall scores. It was as good as or better than all of the other scores at predicting conversion from MCI to AD. It was associated with all our selected imaging parameters for people with MCI and AD. Participants with MCI with an AD CSF signature had somewhat more rapid decline than did those without. This paper illustrates appropriate methods for addressing the different versions of word lists, and demonstrates the additional power to be gleaned with a psychometrically sound composite memory score.     

Tipping the scales: how clinical assessment shapes the neural correlates of Parkinson’s disease mild cognitive impairment

Brain Imaging and Behavior - Mild cognitive impairment in Parkinson’s disease (PD-MCI) is associated with consistent structural and functional brain changes. Whether different approaches for...     

Exploring neural dysfunction in ‘clinical high risk’ for psychosis: A quantitative review of fMRI studies

Individuals at clinical high risk (CHR) of developing psychosis present with widespread functional abnormalities in the brain. Cognitive deficits, including working memory (WM) problems, as commonly elicited by n-back tasks, are observed in CHR individuals. However, functional MRI (fMRI) studies, comprising a heterogeneous cluster of general and social cognition paradigms, have not necessarily demonstrated consistent and conclusive results in this population. Hence, a comprehensive review of fMRI studies, spanning almost one decade, was carried out to observe for general trends with respect to brain regions and cognitive systems most likely to be dysfunctional in CHR individuals. 32 studies were included for this review, out of which 22 met the criteria for quantitative analysis using activation likelihood estimation (ALE). Task related contrast activations were firstly analysed by comparing CHR and healthy control participants in the total pooled sample, followed by a comparison of general cognitive function studies (excluding social cognition paradigms), and finally by only looking at n-back working memory task based studies. Findings from the ALE implicated four key dysfunctional and distinct neural regions in the CHR group, namely the right inferior parietal lobule (rIPL), the left medial frontal gyrus (lmFG), the left superior temporal gyrus (lSTG) and the right fronto-polar cortex (rFPC) of the superior frontal gyrus (SFG). Narrowing down to relatively few significant dysfunctional neural regions is a step forward in reducing the apparent ambiguity of overall findings, which would help to target specific neural regions and pathways of interest for future research in CHR populations.     

Supplementary motor area in spatial coordination of bilateral movements: a new aspect to ‘the SMA debate’?

To test whether the supplementary motor area's (SMA) role is confined to determining the ‘temporal’ but not the ‘spatial’ properties of a movement (H.H. Kornhuber et al., in: W.A. Hershberger (Ed.), Volitional Action. Elsevier, Amsterdam, 1989, pp. 107–168), movement-related scalp-recorded negative DC potential shifts were recorded in bilateral movements requiring complex spatial coordination. In such bilateral continuous rotation movements, the effect of the rotation sense (symmetrical vs. antisymmetrical), i.e. the direction in which an arm or a finger rotated in relation to the otehr, heavily affected DC shifts over the frontocentral midline. Antisymmetrical rotation of upper limb segments was associated with higher negative DC shifts than symmetrical rotation was. This was true for rotations in the sagittal plane, irrespective of whether the rotation involved predominantly proximal muscles (by a rotation predominantly in the shoulder) or only distal muscles (by a rotation in the metacarpo-phalangeal joint of the index finger). If these negative cortical DC-shifts over the frontocentral midline relate to activity of mesial frontocentral structures including the SMA, then the present results suggest that there is a role for these cerebral areas in spatial coordination of bilateral movements. Surprisingly, this was not the case for similar finger movements performed in the frontal plane. The results of the present study and particularly the considering of some fundamentals of theoretical physics and of Popper's philosophy of science, made us revise our assumption motivating the present study, that time and space would represent two orthogonal factors of a movement and that the contributions of a particular cerebral motor area (such as the SMA) to ‘spatial parameters’ versus ‘temporal parameters’ of a movement can thus be teased apart.     

Does a coxib-associated thrombotic risk limit the clinical use of the compounds as analgesic, antiinflammatory drugs? Arguments against

The issue of the risk-benefit assessment of cyclooxygenase-2 (COX-2) inhibitors, as compared to traditional non-steroidal anti-inflammatory drugs (tNSAIDs), is far from being resolved. These compounds need to be carefully re-evaluated in order to avoid hasty conclusions, as it happened when COX-2 inhibitors were introduced into clinical practice. Several arguments support the concept, that COX-2 inhibitors remain a valuable therapeutic option at least for selected patients.