Prioritizing access to psychotherapy services: the client priority rating scale

Determining who gets priority to psychotherapy services within budget‐limited health services remains a dilemma. This study set out to investigate a new method of triage using the Client Priority Rating Scale (CPRS). Clinicians made weighted ratings in the domains of Suicidality, Severity of Presenting Problem, Strength of Internal Coping Resources, Availability of Interim Care Options and Possible Negative Impact of Waiting. The total score was then used to prioritize waiting times for psychotherapeutic services. In order to assess its utility, 68 clients who had been assigned CPRS scores were studied. The CPRS was found to have good inter‐rater reliability and internal consistency. As predicted, those with higher CPRS scores were significantly more likely to commence psychotherapy treatment before those with lower scores. CPRS score was also significantly related to diagnosis and social and psychological functioning. The CPRS method of triage is one approach that determines priority for clients seeking psychotherapy services. Copyright © 2002 John Wiley & Sons, Ltd.     

Colloquium paper: phylogenetic trees and the future of mammalian biodiversity

Phylogenies describe the origins and history of species. However, they can also help to predict species' fates and so can be useful tools for managing the future of biodiversity. This article starts by sketching how phylogenetic, geographic, and trait information can be combined to elucidate present mammalian diversity patterns and how they arose. Recent diversification rates and standing diversity show different geographic patterns, indicating that cradles of diversity have moved over time. Patterns in extinction risk reflect both biological differences among mammalian lineages and differences in threat intensity among regions. Phylogenetic comparative analyses indicate that for small-bodied mammals, extinction risk is governed mostly by where the species live and the intensity of the threats, whereas for large-bodied mammals, ecological differences also play an important role. This modeling approach identifies species whose intrinsic biology renders them particularly vulnerable to increased human pressure. We outline how the approach might be extended to consider future trends in anthropogenic drivers, to identify likely future battlegrounds of mammalian conservation, and the likely casualties. This framework could help to highlight consequences of choosing among different future climatic and socioeconomic scenarios. We end by discussing priority-setting, showing how alternative currencies for diversity can suggest very different priorities. We argue that aiming to maximize long-term evolutionary responses is inappropriate, that conservation planning needs to consider costs as well as benefits, and that proactive conservation of largely intact systems should be part of a balanced strategy.     

Decreasing seroprevalence of human immunodeficiency virus type 1 in a regional blood donor population

Blood banks have intensified their efforts to discourage donations from individuals at risk for the human immunodeficiency virus (HIV-1). Since the onset of HIV-1 donor screening in April 1985, a marked reduction in seroprevalence has been seen at the authors' institutions: from 51 cases per 100,000 donors in 1985 to 13 per 100,000 in the first 6 months of 1988. Data from 3.5 years have been analyzed for temporal trends in the association of HIV-1 seroprevalence with donation site (urban vs. non-urban) and donor gender. The association of HIV-1 seropositivity with an urban donation site decreased through 1987 as the urban-to-nonurban donation odds ratio declined from 6.48 in 1985 to 2.54 in 1987. Despite this decrease, both men and women who donated in urban areas had a significantly higher seroprevalence than those in nonurban areas. Male donors had a higher overall HIV-1 seroprevalence than female donors. However, the male-to-female odds ratio declined from 2.94 in 1985 to 1.96 in 1988, and male gender was no longer significantly associated with HIV-1 seropositivity. This change in the donor profile appears to reflect declining numbers of seropositive men who acknowledge risk factors and greater numbers of women with no identified risks for HIV-1. This study documents a dramatic decrease in HIV-1-seropositive donors and suggests that the deferral of high-risk individuals has become increasingly successful.     

Biochanin A, a naturally occurring inhibitor of fatty acid amide hydrolase

Background and purpose:

Inhibitors of fatty acid amide hydrolase (FAAH), the enzyme responsible for the metabolism of the endogenous cannabinoid (CB) receptor ligand anandamide (AEA), are effective in a number of animal models of pain. Here, we investigated a series of isoflavones with respect to their abilities to inhibit FAAH.

Experimental approach:

In vitro assays of FAAH activity and affinity for CB receptors were used to characterize key compounds. In vivo assays used were biochemical responses to formalin in anaesthetized mice and the ‘tetrad’ test for central CB receptor activation.

Key results:

Of the compounds tested, biochanin A was adjudged to be the most promising. Biochanin A inhibited the hydrolysis of 0.5 µM AEA by mouse, rat and human FAAH with IC₅₀ values of 1.8, 1.4 and 2.4 µM respectively. The compound did not interact to any major extent with CB₁ or CB₂ receptors, nor with FAAH-2. In anaesthetized mice, URB597 (30 µg i.pl.) and biochanin A (100 µg i.pl.) both inhibited the spinal phosphorylation of extracellular signal-regulated kinase produced by the intraplantar injection of formalin. The effects of both compounds were significantly reduced by the CB₁ receptor antagonist/inverse agonist AM251 (30 µg i.pl.). Biochanin A (15 mg·kg⁻¹ i.v.) did not increase brain AEA concentrations, but produced a modest potentiation of the effects of 10 mg·kg⁻¹ i.v. AEA in the tetrad test.

Conclusions and implications:

It is concluded that biochanin A, in addition to its other biochemical properties, inhibits FAAH both in vitro and peripherally in vivo.This article is part of a themed issue on Cannabinoids. To view the editorial for this themed issue visit http://dx.doi.org/10.1111/j.1476-5381.2010.00831.x     

Linear growth in early treated children with congenital hypothyroidism

Length/height was studied from birth to 6 years of age in 103 children with congenital hypothyroidism identified by the Norwegian or Swedish screening programs. We used the "infancy-childhood-puberty (ICP) growth model". This model describes normal linear growth during the first 3 years of life by an infancy component with the addition of a childhood component, the latter acting from the second half of the first year. In comparison with reference children, children with hypothyroidism had reduced growth from 6 to 12 months, and increased growth after 12 months of age. Mean onset of the childhood component of growth was delayed from 8.1 months (SD 1.9) to 10.4 months (SD 2.2) in girls, and from 8.9 months (SD 2.0) to 11.0 months (SD 2.1) in boys. Age at onset of the childhood component was correlated with age at start of treatment ( r = 0.24), and in children with more severe hypothyroidism (pretreatment serum thyroxine <40 nmol/l) inversely correlated with the L-thyroxine dose at start of treatment ( r = -0.40). Change in height standard deviation score from 1 to 3 years of age was correlated with the serum thyroxine concentration at age 1 year ( r = 0.30). The delay in the onset of the childhood component of growth and the association with age at start of treatment and initial L-thyroxine dose indicate that thyroid hormones during the first months of life are essential for normal onset of the childhood component of growth, which otherwise is assumed to be growth hormone-dependent.     

Phase II evaluation of diaziquone (CI-904, AZQ) in the treatment of human malignant glioma

Summary Diaziquone, a new alkylating agent which crosses the blood brain barrier, has shown a 20% response rate in phase II studies in heavily pretreated patients. We have treated 23 patients at our institution as part of a multicentric phase II European trial of diaziquone. All had histologically proven malignant glioma unequivocally progressing on CT scan. Prior therapy had consisted of surgical excision (13 patients), cobalt radiotherapy to CNS (13 patients), and chemotherapy with nitrosourea derivatives (11 patients). Six patients had no prior therapy. Median age was 42 years (range 22–69) and performance status was 3+ or better. They were treated with monthly courses of diaziquone 5.5 mg/m² I.V. (10 min.) × 5 days. Dosage adjustments were made according to leucocyte and platelet nadirs. Thrombocytopenia was the dose limiting toxicity. Very mild gastrointestinal toxicity was observed. One patient developed hemolytic anemia. One complete response (clinical and CT scan), 7 partial clinical responses (3: > 50%, 4: 25–50%), and 1 disease stabilization (<25%) were documented. The longest response has now lasted over 26 months. These preliminary results show that chemotherapy with diaziquone can achieve a response rate as high as 35% in malignant glioma even in patients previously treated with a chemotherapy regimen including a nitrosourea (four of the seven objective responses were seen in such patients). Diaziquone is well tolerated and deserves further study in the management of malignant glioma. Address for offprints: Dr J Maral, Medical Oncology Service, Hôpital de la Salpetriere, 75651 Paris Cedex 13, France     

Quality assurance in drug and alcohol treatment: the development of standards for treatment content

The need for minimum standards of service delivery in drug and alcohol treatment agencies is outlined, and the Australian standards developed to date are discussed. It is argued that such standards are insufficient to assure the efficacy of treatment approaches used in treatment agencies, although they are an important and necessary precursor to the implementation of patterns of optimum care. The nature of optimum care standards is outlined and one methodology for developing optimum standards is described.     

房间隔缺损介入封堵术并发症的预防及护理

1临床资料2003-12/2005-01收治房间隔缺损(ASD)24(男15,女9)例,年龄2～68岁,体质量10～72 kg.经心脏X线三位片、心电图、彩色多普勒超声心动图确诊为继发型ASD.经彩色多普勒超声心动图显示ASD直径为4～32 mm,选择的封堵器直径为10～42 mm.结果: 1例术中因封堵器脱落经外科手术抢救治疗无效死亡,1例术后2 d出现Ⅱ度Ⅱ型房室传导阻滞,经药物治疗7 d痊愈,余22例封堵器置入治疗患者无并发症发生,疗效满意.     

Peripheral pseudoaneurysms: evaluation with duplex US

The prospectively generated results of 64 duplex sonographic examinations in 59 patients being evaluated for peripheral pseudoaneurysms over a 2-year period were reviewed. Subsequently, two groups of patients were identified. Group 1 (45 examinations) presented with relatively acute symptoms after arterial puncture, and group 2 (19 examinations) had undergone previous vascular surgical procedures and were usually asymptomatic. Duplex sonography demonstrated high sensitivity (94%) and specificity (97%) for the diagnosis of pseudoaneurysm in group 1. Of the 19 studies in group 2, duplex sonography allowed correct identification of pseudoaneurysms in four studies and exclusion of this entity in six examinations. The duplex sonographic findings in nine studies in this group did not allow differentiation of pseudoaneurysm from true aneurysm or oversize graft anastomosis. Duplex sonography is suggested as a primary radiologic method for evaluating possible pseudoaneurysms after arterial puncture, and it may provide valuable information and a means of postsurgical follow-up of selected patients as well.