Experiences with psychotherapy for depression in routine care: a naturalistic patient survey in Germany

The present survey assessed consumer satisfaction of patients having undergone psychotherapy for depression as well as service characteristics including treatment access, communication of diagnosis and treatment rationale, quality assurance and adverse events. The study was conducted in the form of a 15‐item questionnaire that was published in one of Germany's leading health magazines. 473 persons responded (81.5% women, age range 17–83). 49.8% of the respondents reported substantial or reasonable improvement; two out of three patients stated they had been satisfied with their therapy. Improvement and satisfaction were greater in those patients who had been informed about diagnosis and treatment; they were lower when unpleasant experiences were reported. Methodological restrictions of the study are outlined and hypotheses about potential strengths and deficits in the delivery of psychotherapy for depression in Germany are proposed. Copyright © 2006 John Wiley & Sons, Ltd.     

Treatment of horizontal root‐fractured maxillary incisors – a case report

Abstract – Traumatic dental injuries often occur to the teeth and their supporting tissues and they are the main reasons for emergency visit to a dental clinic. Management of a fracture depends on its position and the extent of root involvement. Horizontal root fractures are not seen frequently and the treatment consists of reduction and long‐term rigid fixation of the coronal segment. The present case demonstrates the successful management of two horizontally fractured maxillary central incisors with a follow‐up period of 9 months.     

纯氧和空气复苏患儿24个月随访观察

目的 探讨纯氧和空气复苏对新生儿发育的影响,为新生儿复苏用氧选择提供依据.方法 对2005年1月-2007年1月在保定市妇幼保健院进行窒息复苏的30例患儿在24个月时进行随访,依据复苏用氧浓度分为纯氧复苏组(20例)和空气复苏组(10例),内容包括出生时胎龄、出生体重、身长、头围、阿氏评分(1 min,5 min)、心率(1 min,5 min)、随访时体重、身长、头围及运动发育标志(坐、爬、站、走时间).结果 出生时患儿身体数据差异无统计学意义,24个月随访,患儿身高、体重、头围及运动发育标志差异均无统计学意义(P>0.05).结论 空气复苏对新生儿窒息患者是安全有效的.     

Working‐correlation‐structure identification in generalized estimating equations

Selecting an appropriate working correlation structure is pertinent to clustered data analysis using generalized estimating equations (GEE) because an inappropriate choice will lead to inefficient parameter estimation. We investigate the well‐known criterion of QIC for selecting a working correlation structure, and have found that performance of the QIC is deteriorated by a term that is theoretically independent of the correlation structures but has to be estimated with an error. This leads us to propose a correlation information criterion (CIC) that substantially improves the QIC performance. Extensive simulation studies indicate that the CIC has remarkable improvement in selecting the correct correlation structures. We also illustrate our findings using a data set from the Madras Longitudinal Schizophrenia Study. Copyright © 2008 John Wiley & Sons, Ltd.     

Assessing ethical problem solving by reasoning rather than decision making

Context The assessment of ethical problem solving in medicine has been controversial and challenging. The purposes of this study were: (i) to create a new instrument to measure doctors’ decisions on and reasoning approach towards resolving ethical problems; (ii) to evaluate the scores generated by the new instrument for their reliability and validity, and (iii) to compare doctors’ ethical reasoning abilities between countries and among medical students, residents and experts. Methods This study used 15 clinical vignettes and the think‐aloud method to identify the processes and components involved in ethical problem solving. Subjects included volunteer ethics experts, postgraduate Year 2 residents and pre‐clerkship medical students. The interview data were coded using the instruments of the decision score and Ethical Reasoning Inventory (ERI). The ERI assessed the quality of ethical reasoning for a particular case (Part I) and for an individual globally across all the vignettes (Part II). Results There were 17 Canadian and 32 Taiwanese subjects. Based on the Canadian standard, the decision scores between Taiwanese and Canadian subjects differed significantly, but made no discrimination among the three levels of expertise. Scores on the ERI Parts I and II, which reflect doctors’ reasoning quality, differed between countries and among different levels of expertise in Taiwan, providing evidence of construct validity. In addition, experts had a greater organised knowledge structure and considered more relevant variables in the process of arriving at ethical decisions than did residents or students. The reliability of ERI scores was 0.70–0.99 on Part I and 0.75–0.80 on Part II. Conclusions Expertise in solving ethical problems could not be differentiated by the decisions made, but could be differentiated according to the reasoning used to make those decisions. The difference between Taiwanese and Canadian experts suggests that cultural considerations come into play in the decisions that are made in the course of providing humane care to patients.     

Sonographic diagnosis of early recurrence after inguinal herniorrhaphy: Potential pitfalls

Three patients who presented with scrotal swelling within a few days of inguinal herniorrhaphy are reported. Ultrasonography scans performed in these patients all demonstrated features suspicious of recurrence of hernia. One patient underwent surgical exploration, which revealed only a scrotal haematoma without evidence of recurrent hernia. The other two patients were managed conservatively because clinically the swellings were regarded to be more compatible with haematoma. Both patients had subsequent resolution of the scrotal swelling with no clinical evidence of recurrence of hernia on follow‐up. It is concluded that sonographic diagnosis of recurrence of hernia shortly after inguinal herniorrhaphy can occasionally be misleading.