Risk factors for ineffective therapy in patients with bloodstream infection

BACKGROUND: Infections occurring among outpatients having recent contact with the health care system have been termed health care-associated infections. The objective of this study was to analyze the impact of health care-associated status on effectiveness of initial therapy in hospitalized patients with bloodstream infections. METHODS: Prospective cohort study of adults with bloodstream infections at 3 North Carolina hospitals. Bloodstream infection was defined as health care-associated if it occurred within the first 48 hours after hospitalization and if patients had 1 of the following characteristics: had received home health services, outpatient intravenous therapy, or outpatient renal dialysis in the 30 days prior to hospital admission; had been hospitalized within 90 days prior to admission; or lived in a long-term care facility. RESULTS: Of 466 bloodstream infections, 132 (28%) were community-acquired, 178 (38%) were health care-associated, and 156 (33%) were nosocomial. Multivariable logistic regression using community-acquired status as a reference identified health care-associated status (odds ratio, 3.1; 95% confidence interval, 1.6-6.1) and nosocomial status (odds ratio, 4.3; 95% confidence interval, 2.2-8.3) as independent predictors of ineffective initial antibiotic therapy. Among health care-associated characteristics, hospitalization in the 90 days prior to admission was independently associated with ineffective initial therapy (odds ratio, 2.4; 95% confidence interval, 1.4-4.2). CONCLUSIONS: Among patients treated in the hospital for bloodstream infection, health care-associated status was an independent predictor of ineffective initial antibiotic therapy. Hospitalization within 90 days prior to hospital admission was the component of health care-associated status most strongly associated with ineffective initial therapy.     

Near-hanging injury

Near-hanging injury results in multisystem insult and injury. Acute or delayed respiratory complications can result in death. A survivor can suffer neuropsychiatric sequelae ranging from amnesia to a prolonged vegetative state. Treatment is directed toward ensuring cerebral oxygenation, lowering increased intracranial pressure, and treating respiratory distress. Psychiatric consultation will be necessary in long-term survivors. Patients should be observed for at least 24 hours after a near-hanging injury.     

A retrospective follow-up study of body dysmorphic disorder

BACKGROUND: Although research on body dysmorphic disorder (BDD) is increasing, no follow-up studies of this disorder's course of illness have been published. METHODS: The status of 95 outpatients with BDD treated in a clinical practice was assessed by chart review. Standard scales were used to rate subjects at baseline and the most recent clinic visit (mean duration of follow-up, 1.7 +/- 1.1; range, 0.5-6.4 years). Ratings were also done at 6-month intervals over the first 4 years of follow-up. RESULTS: Allowing for censoring, life table analysis estimated that the proportion of subjects who achieved full remission from BDD at the 6-month and/or 12-month assessment was 24.7%; the proportion who attained partial or full remission at 6 months and/or 12 months was 57.8%. After 4 years of follow-up, 58.2% had experienced full remission, and 83.8% had experienced partial or full remission, at one or more 6-month assessment points. Of those subjects who attained partial or full remission at one or more assessment points, 28.6% subsequently relapsed. Between baseline and the most recent assessment, BDD severity and functioning significantly improved: at the most recent assessment, 16.7% of subjects were in full remission, 37.8% were in partial remission, and 45.6% met full criteria for BDD. Greater severity of BDD symptoms and the presence of major depression or social phobia at baseline were associated with more severe BDD symptoms at study end point. All subjects received at least one medication trial, and 34.3% received some type of therapy during the follow-up period. CONCLUSIONS: A majority of treated patients with BDD improved, although improvement was usually partial. Prospective longitudinal studies are needed to further elucidate the course of BDD.     

Breast cancer and depression

Major depression and depressive symptoms, although commonly encountered in patients with medical illnesses, are frequently underdiagnosed and undertreated in women with breast cancer. Depression and its associated symptoms diminish quality of life, adversely affect compliance with medical therapies, and reduce survival. Treatment of depression in women with breast cancer improves their dysphoria and other depressive symptoms, enhances quality of life, and may increase longevity. In this review, studies that investigate pathophysiologic alterations in patients with cancer and comorbid depression are discussed, and the few studies on treatment of depression and related symptoms in women with breast cancer are examined.     

Longitudinal diagnostic efficiency of DSM-IV criteria for obsessive-compulsive personality disorder: a 2-year prospective study

OBJECTIVE: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive-compulsive personality disorder (OCPD). METHOD: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. RESULTS: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of 'preoccupied with details', 'rigid and stubborn', and 'reluctant to delegate'. CONCLUSION: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.     

Oculomotor control in asymptomatic and recently diagnosed individuals with the genetic marker for Huntington's disease

We compared oculomotor control among individuals in the early stages of Huntington's disease (HD), with that of individuals who are presymptomatic HD gene carriers (PSGC) and nongene carriers (NGC). The oculomotor testing paradigm included both traditional tests and a novel experimental procedure to assess visual scanning. Traditional tests elicited saccades, pursuit and optokinetic nystagmus (OKN). HD patients demonstrated marked delay in the initiation of volitional saccades (anti-saccade and memory-guided saccades), a reduced number of correct volitional saccades, reduced velocity of saccades, and a decreased OKN gain. We also studied visual scanning while the participants completed the Digit Symbol Subscale of the Wechsler Adult Intelligence Survey-Revised (WAIS-R). The HD participants demonstrated an abnormal gaze strategy, which may be associated with attention and/or planning deficits. Differences between the PSGC and NGC groups were only observed for two measures: PSGC had a decreased number of memory-guided saccades and a subtle delay in the initiation of volitional saccades. Our results suggest that oculomotor measures are a sensitive biomarker in the early stage of HD and demonstrate that the combination of more traditional oculomotor tests with visual scanning tests is useful in the evaluation of visual performance.     

Psychological characteristics and factors related to willingness to donate again among anonymous oocyte donors

OBJECTIVE: To assess post-donation psychological status of a large sample of professionally recruited, paid anonymous donors and to determine whether there were any differences between those who were willing to donate again and those who were not. DESIGN: Cross-sectional survey. SETTING: Healthy donors who were recruited by two private groups. SUBJECT(S): One hundred fifteen donors who had completed at least one donation cycle at one of six IVF programs in a large Midwestern city. INTERVENTION(S): None. MAIN OUTCOME MEASURES: Self-report questionnaire assessing psychological symptoms, self-esteem, expectations, satisfaction, and attitudes toward donation. RESULT(S): Psychological symptomatology and self-esteem were in the normal range. Altruism and compensation were the two most frequently cited motivators for donation. Of the donors, 82% were moderately to very satisfied with the donation experience. First-time donors were significantly younger, reported more post-donation psychiatric symptoms, and had slightly lower self-esteem. Of the donors, 35% stated they would donate again; 37% would not, and 28% were undecided. Donors who were willing to donate again reported significantly less ambivalence about donation and significantly greater satisfaction with the medical aspects of donation. CONCLUSION(S): Approximately one third of donors are willing to donate more than once. These women report less ambivalence and greater satisfaction with the donation experience.     

Divergent findings regarding negative priming in Parkinson's disease: A comment on Filoteo et al. (2002) and Wylie and Stout (2002)

This commentary discusses divergent findings in 2 articles published in this issue of Neuropsychology. The studies used negative priming (NP) to probe the associations between basal ganglia function and cognition in Parkinson's disease (PD) and tested different predictions about NP in PD. Different NP tasks were used, and although the subject samples appeared to have similar clinical features, results were quite different. This commentary, written jointly by the authors of the 2 studies (J. V. Filoteo, L. M. Rilling, & D. L. Strayer, 2002; S. A. Wylie & J. C. Stout, 2002), describes a process by which their disparate results may be used to facilitate the design of new studies that may determine how specific features of NP tasks lead to different findings in PD. The results are a more systematic account of how task features, such as specific response demands, interact with the response selection processes that are implemented by the basal ganglia.