Development and evaluation of a diagnostic algorithm for depression in childhood

This paper describes the development and validation of a brief questionnaire intended for the rapid assessment of depression in childhood. It is primarily a clinical interview but there is an associated algorithm for the diagnosis of a syndrome of depression. It can equally be used for the clinical diagnosis of a depressive disorder. The current battery includes features representative both of depressive cognitions and endogenous depression. However, it is less effective in the identification of a syndrome of endogenous depression than depressive cognitions.

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Zusammenfassung Wir stellen die Entwicklung und Validierung eines kurzen Fragebogens vor, der zur raschen Feststellung einer Depression im Kindesalter dienen soll. Es handelt sich primär um ein klinisches Interview, aber es gibt zusätzlich einen Algorithmus für die Diagnosestellung eines depressiven Syndroms. Er kann ebenso für die klinische Diagnose einer depressiven Störung benutzt werden. Die vorliegende Batterie umfaßt Merkmale, die sowohl für depressive Kognitionen als auch für die endogene Depression repräsentativ sind. Jedoch können erstere hiermit besser identifiziert werden als das Syndrom einer endogenen Depression.

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Résumé Ce travail décrit le développement et la calidation d'un bref questionnaire ayant pour but l'évaluation repide de la dépression dans l'enfance. Il est en premier un interview clinique, mais il y a un algorythme associé pour le diagnostic d'un syndrome de dépression. Il peut également être utilisé pour le diagnostic clinique d'un trouble dépressif. La batterie courante comprend des traits représentatifs à la fois des cognitions dépressives et de la dépression endogène. Cependant, il est moins efficace dans l'identification d'un syndrome de dépression endogène que dans le cas des cognitions dépressives.

     

The Janus principle

The leaders who guide health organizations into formal and informal alliances must serve their own organizations while meeting the demands of a larger environment. Those who recognize the need for change in leadership style are most likely to help their organizations to maintain their strengths within new structures. The authors examine several theories of leadership style, describe the developmental stages involved in forming an inter-institutional organization, and discuss the new leadership tasks and skills that collaboration mandates.     

Stable weight during lamotrigine therapy: a review of 32 studies

A side effect associated with the use of some antiepileptic drugs (AEDs) is change in body weight. To evaluate the effect of lamotrigine on body weight in adult patients with epilepsy, we conducted a retrospective review of data from 463 patients treated with lamotrigine in 32 clinical trials. Mean daily dose was 259 (+/-155) mg and duration of therapy was 318 (+/-87) days. The mean change in body weight was 0.5 (+/-5) kg. Lamotrigine was associated with stable body weight in patients with epilepsy.     

Randomized trial of two intravenous schedules of the topoisomerase I inhibitor liposomal lurtotecan in women with relapsed epithelial ovarian cancer: a trial of the national cancer institute of Canada clinical trials group.

PURPOSE: Liposomal lurtotecan (OSI-211) is a liposomal formulation of the water-soluble topoisomerase I inhibitor lurtotecan (GI147211), which demonstrated superior levels of activity compared with topotecan in preclinical models. We studied two schedules of OSI-211 in a randomized design in relapsed ovarian cancer to identify the more promising of the two schedules for further study. PATIENTS AND METHODS: Eligible patients had measurable epithelial ovarian, fallopian, or primary peritoneal cancer that was recurrent after one or two prior regimens of chemotherapy. Patients were randomly assigned to receive either arm A (OSI-211 1.8 mg/m(2)/d administered by 30-minute intravenous infusion on days 1, 2, and 3 every 3 weeks) or arm B (OSI-211 2.4 mg/m(2)/d administered by 30-minute intravenous infusion on days 1 and 8 every 3 weeks). The primary outcome measure was objective response, which was confirmed by independent radiologic review, and a pick the winner statistical design was used to identify the schedule most likely to be superior. RESULTS: Eighty-one patients were randomized between October 2000 and September 2001. The hematologic toxic effects were greater on arm A than on arm B (grade 4 neutropenia, 51% v 22%, respectively), as was febrile neutropenia (26% v 2.4%, respectively). Of the 80 eligible patients, eight patients (10%) had objective responses; six responders (15.4%; 95% CI, 6% to 30%) were in arm A and two responders (4.9%; 95% CI, 1% to 17%) were in arm B. CONCLUSION: The OSI-211 daily for 3 days intravenous schedule met the statistical criteria to be declared the winner in terms of objective response. This schedule was also associated with more myelosuppression than the schedule of OSI-211 administered in arm B.     

A Review of the Proceedings from the 2008 NICHD Workshop on Standardized Nomenclature for Cardiotocography: Update on Definitions, Interpretative Systems With Management Strategies, and Research Priorities in Relation to Intrapartum Electronic Fetal Monitoring

Despite evidence demonstrating no neonatal benefit, the medicolegal climate in the United States requires obstetricians to integrate continuous intrapartum surveillance into their care of the pregnant laboring patient. The intent of this article is to familiarize the reader with the most recent, standardized, quantitative nomenclature recommended to describe intrapartum CTG in order to reduce miscommunication among providers caring for the laboring patient, propagate consistent, evidence-based responses to CTG patterns, and systematize the terminology used by researchers investigating intrapartum CTG.Key words: Intrapartum cardiotocography, Electronic fetal monitoring, NICHD nomenclatureIn 2002, approximately 3.4 million fetuses (85% of approximately 4 million live births) in the United States were assessed with continuous cardiotocography (CTG), making it the most commonly performed obstetric procedure.¹ Although CTG, also known as electronic fetal monitoring, is widespread in developed nations, its ability to identify the fetus that may be becoming asphyxiated and therefore may benefit from intervention is limited, and has failed to lead to reduced rates of cerebral palsy and neurologic injury. There are no studies comparing CTG with an absence of intrapartum monitoring, but trials comparing CTG with intermittent auscultation show no reduction in the overall risk of perinatal death (relative risk [RR] 0.85; 95% confidence interval [95% CI], 0.59–1.23) or cerebral palsy (RR 1.74; 95% CI, 0.97–3.11).² What studies have demonstrated is that CTG versus intermittent auscultation leads to higher operative delivery rates by cesarean or assisted vaginal delivery (RR 1.66; 95% CI, 1.30–2.13 and RR 1.16; 95% CI, 1.01–1.32, respectively).²Despite compelling evidence demonstrating no neonatal benefit, the medicolegal climate in the United States requires obstetricians to integrate continuous intrapartum surveillance into their care of the pregnant laboring patient. Due to the setup of labor and delivery units and the team-oriented approach that exists in most facilities, nurses, residents, nurse midwives, and physicians may all be regularly involved in assessing the CTG. To communicate effectively in the event that an abnormal CTG exists and invoke an appropriate level of concern, standardized terminology is necessary.^3,4In 1997, the National Institutes of Child Health and Human Development (NICHD) sponsored a Research Planning Workshop that addressed this issue. The workshop’s express purpose was to develop “a standardized and rigorously, unambiguously described set of definitions that can be quantitated” for electronic fetal heart monitoring, with the ultimate goal of producing a common language that would facilitate further investigational research examining the predictive value of electronic fetal monitoring and management strategies to recognize and reduce intrapartum fetal compromise.⁵ The American College of Obstetricians and Gynecologists (ACOG); the Association of Women’s Health, Obstetric and Neonatal Nurses; the Royal College of Obstetricians and Gynaecologists; and the Society of Obstetricians and Gynaecologists of Canada not only endorsed the definitions, but recommended new interpretations, definitions, and particular intrapartum management actions for some situations.In April 2008, the NICHD, ACOG, and the Society for Maternal-Fetal Medicine (SMFM) jointly sponsored a workshop on CTG, or fetal heart rate (FHR) patterns. The goals of this workshop⁶ were (1) to review and update the definitions for CTG pattern categorization as compared with the prior workshop, (2) to assess existing classification systems for interpretation of particular CTG patterns and make new recommendations for a system to be employed in the United States, and (3) to make recommendations for research priorities as they relate to CTG. The intent of this article is to familiarize the reader with the resulting standardized, quantitative nomenclature that is recommended to describe intrapartum CTG to reduce miscommunication among providers caring for the laboring patient, as well as systematize the terminology used by researchers investigating intrapartum CTG. A new emphasis on interpretative systems and recommended management strategies, as set forth by the recent 2008 joint workshop, is also included and reviewed in detail.