The change in electrical energy delivered to aged patients over a course of moderate dose unilateral electroconvulsive therapy

Background: To prove effective, the electrical energy delivered as part of unilateral electroconvulsive therapy (ECT) must exceed the seizure threshold. Although high dose treatment (six times the threshold) is most effective, it results in more cognitive deficits to which aged patients are especially vulnerable. As a compromise, Australian psychogeriatricians often prescribe moderate dose (three times the threshold) treatment. However, older patients' thresholds sometimes rise steeply as treatment progresses. If energy levels are kept low to make treatment safer, the result might be that patients' recovery is delayed. We report here on changes in prescribed energy over a course of six unilateral treatments. Methods: A retrospective review of data collected routinely on 42 depressed patients aged ≥65 years given moderate dose unilateral ECT in five aged psychiatry services in Victoria, Australia. Results: Prescribed energy rose with time, but only 31% of patients reached high dose levels by their sixth treatment. Conclusions: We cannot comment on the safety or effectiveness of moderate dose ECT. We focus instead just on changes in prescribed energy levels. These did not rise quickly in most cases, suggesting that moderate dose ECT cannot be dismissed as a treatment option simply because of the rate of change in electrical stimulation.     

Cancer patients and positive sensory impressions in the hospital environment – a qualitative interview study

TIMMERMANN C., UHRENFELDT L. & BIRKELUND R. (2013) European Journal of Cancer Care 22 , 117–124 Cancer patients and positive sensory impressions in the hospital environment – a qualitative interview study This study explores how cancer patients experience the meaning of positive sensory impressions in the hospital environment such as architecture, decoration and the interior. Data were obtained at a general hospital in Denmark by interviewing six cancer patients at two different wards. The analysis process was guided by the hermeneutical–phenomenological theory of interpretation as presented by the French philosopher Paul Ricoeur. Two main themes were identified: to preserve identity and positive thoughts and feelings. The participants experienced that positive sensory impressions in the hospital environment had a significant impact on their mood, generating positive thoughts and feelings. A view to nature also helped them to forget their negative thoughts for a while. The possibility of having a view helped some cancer patients to connect with good memories and personal life stories that enabled them to recall some of their feelings of identity. This paper adds knowledge about how cancer patients experience sensory impressions in the hospital environment. An environment that provides homeliness and offers a view to nature seems to help some patients to preserve their identity. Furthermore, positive sensory impressions and the opportunity for recreation through environmental facilities strengthen the patient's positive thoughts and feelings.     

Relationships of serum free thyroxine and erythrocyte measures in euthyroid HFE C282Y homozygotes and control subjects: the HEIRS Study

Hemoglobin (Hb) levels and mean corpuscular volume (MCV) are abnormal in some persons with hemochromatosis or thyroid disorders. We sought to determine whether serum free thyroxine (T4) affects erythrocyte measures in euthyroid adults with or without C282Y homozygosity. We evaluated 488 white HFE C282Y homozygotes and controls (no HFE C282Y or H63D; normal serum iron measures) identified in screening; we excluded those with thyroid disorders, anemia, erythrocytosis, or serum ferritin (SF) <34 pmol/l. In the remaining 141 C282Y homozygotes and 243 controls, we evaluated correlations of log₁₀ free T4 with Hb, RBC, MCV, and red blood cell distribution width (RDW). C282Y homozygotes had lower mean age, higher mean Hb, MCV, and log₁₀ SF, and lower mean RBC and RDW than controls; mean log₁₀ free T4 did not differ significantly. In HFE C282Y homozygotes, there was no significant correlation of log₁₀ T4 with erythrocyte measures. In controls, there was a positive correlation of log₁₀ T4 with Hb (P = 0.0096) and a negative correlation with RDW (P = 0.0286). Among euthyroid white adults without iron deficiency, there are significant correlations of log₁₀ free T4 with Hb and RDW in controls, but not in HFE C282Y homozygotes.     

Project MATCH secondary a priori hypotheses

Aims. (1) To assess the benefits of matching alcohol dependent clients to three treatments, based upon a priori hypotheses involving 11 client attributes; (2) to discuss the implications of these findings and of matching hypotheses previously reported from Project MATCH. Setting and participants. (1) Clients receiving outpatient therapy (N = 952; 72% male); (2) clients receiving aftercare therapy following inpatient or day hospital treatment (N = 774; 80% male). Intervention. Clients were randomly assigned to one of three 12-week, manual-guided, individual treatments: Cognitive Behavioral Coping Skills Therapy (CBT), Motivational Enhancement Therapy (MET) or Twelve-Step Facilitation Therapy (TSF). Design. Two parallel but independent randomized clinical trials were conducted, one with outpatients, one with aftercare clients. Participants were monitored over 15 months including a 1-year post-treatment period. Individual differences in response to treatment were modeled as a latent growth process and evaluated for 17 contrasts specified a priori. Outcome measures were percentage of days abstinent and drinks per drinking day. Findings. Two a priori contrasts demonstrated significant post-treatment attribute by treatment interactions: (1) outpatients high in anger and treated in MET had better post-treatment drinking than in CBT; (2) aftercare clients high in alcohol dependence had better post-treatment outcomes in TSF; low dependence clients did better in CBT. Other matching effects varied over time, while still other interactions were opposite that predicted. Conclusions. (1) Anger and dependence should be considered when assigning clients to these three treatments; (2) considered together with the results of the primary hypotheses, matching effects contrasting these psychotherapies are not robust. Possible explanations include: (a) among the client variables and treatments tested, matching may not be an important factor in determining client outcomes; (b) design issues limited the robustness of effects; and (c) a more fully specified theory of matching is necessary to account for the complexity of the results.     

Assessment of haemophilia treatment practice pattern in Japan

Summary.  The current status of replacement therapy for haemophilia and the role played by nurses in Japan were investigated at 16 facilities (17 specialties) each providing care to 20 or more haemophilia A or B patients without inhibitor. The questionnaire was mailed to the nurse or physician in charge of haemophilia at each facility in August 2006, asking the nurse to fill in the questionnaire. Responses were collected on 1318 patients (haemophilia A: 1078 patients; haemophilia B: 240 patients). About 70% of these patients were reported to be severe haemophilia A or B. Overall, 26% were receiving regular prophylaxis while 74% received on-demand therapy with or without temporary prophylaxis before special events. The percentage of patients receiving primary prophylaxis was only 2%. The percentage of adherence to prophylaxis decreased with age (lowest at age 19–29) but this percentage for each age group in Japan was higher than that in the western countries. Of the nurses working at the facilities surveyed, 88% considered prophylaxis as an optimal therapy for severe haemophilia patients, although the percentage of patients receiving prophylaxis for the entire population surveyed was lower than that in the western countries. The main factor precluding introduction of prophylaxis was 'difficulty in venous access' for infants and small children. On the other hand, 'unwillingness of family members' and 'poor adherence' were the main factors precluding introduction of this therapy for those aged over 6 years.     

POPULATION DISTRIBUTION OF ALCOHOL DEHYDROGENASE CLASS I IN FRANCE: COMPARISON WITH OTHER POPULATIONS, AND DISTRIBUTION WITH RESPECT TO GENDER AND AGE

In Caucasians, a genetic polymorphism is known for some alcoholdehydrogenase (ADH) systems (ß and     

Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium

Background: Pentobarbital and propofol are commonly used to sedate children undergoing magnetic resonance imaging (MRI). The Pediatric Sedation Research Consortium (PSRC) was created in 2003 to improve pediatric sedation process and outcomes. Objective: To use PSRC records to compare the effectiveness, efficiency and adverse events of propofol vs pentobarbital for sedation of children undergoing MRI. Methods: Pediatric Sedation Research Consortium records of children aged 6 months to 6 years who were primarily sedated with either i.v. pentobarbital or propofol were included. Participating PSRC investigators obtained institutional review board approval before data collection. Results: Of 11 846 sedations for MRI, 7079 met inclusion criteria (propofol: n = 5072; pentobarbital: n = 2007). Demographic details were similar between the two groups. Ideal sedation was produced in 96.45% of the pentobarbital group and in 96.8% of the propofol group (P = 0.478), but pentobarbital was more likely to result in poor sedation canceling the procedure (OR 5.88; CI 2.24, 15.40). Propofol resulted in physiologic changes more frequently than did pentobarbital (OR 5.69; CI 1.35, 23.97). Pentobarbital was associated with prolonged recovery (OR 16.82; CI 4.98, 56.8), unplanned admission (OR 5.60; CI 1.02, 30.82), vomiting (OR 36.76; CI 4.84, 279.2) and allergic complication (OR 9.15; CI 1.02, 82.34). The incidence of airway complications was not significantly different between the two. The median recovery time for patients receiving propofol was 30 min, whereas for pentobarbital it was 75 min (P < 0.001). Conclusion: Among institutions contributing data to the PSRC, it is found that propofol provides more efficient and effective sedation than pentobarbital for children undergoing MRI. Although apnea occurred with a greater frequency in patients who received propofol, the rate of apnea and airway complications for propofol was not statistically different from that seen in patients who received pentobarbital.     

The Beta-Blocker Pooling Project (BBPP): subgroup findings from randomized trials in post infarction patients

The objective of the Beta-Blocker Pooling Project (BBPP) wasto collect and analyse data from the major long-term secondaryprevention trials in order to determine whether there are subsetsof post-infarction patients who benefit to a greater or lesserextent from beta-blocker therapy than the average patient population. One-year all-cause mortality data from nine trials involving13 679 patients were obtained. Overall, mortality was 24% lowerin the beta-blocker group compared to the placebo group. However,there was heterogeneity among the results of the trials, whichtested seven different beta-blockers. Subgroups with high placebogroup mortality (e.g. patients with a history of previous myocardialinfarction (MI), angina pectoris, mechanical or electrical complications,and digitalis usage) seemed to benefit particularly from beta-blockertreatment. These findings were consistent in the nine trials.Patients in the lower risk subgroups also appeared to benefitfrom beta-blockers, but this benefit was smaller in absoluteterms and inconsistent across the trials. There was no evidencethat treatment outcome was related to gender, baseline levelof heart rate or blood pressure, or time of initiation of treatmentafter hospital admission. In conclusion, the Pooling Projectindicates that high risk MI patients, without contraindicationsto beta-blockers, are the prime candidates for long-term therapy,but the lower risk patients may also receive some benefit.