Upper and midureteral calculi: percutaneous extraction with an occlusion balloon catheter

In 44 patients with one or more calculi in the upper two-thirds of the ureter, single-stage percutaneous nephrolithotomy was performed through a middle or upper calyceal nephrostomy after cystoscopic placement of an occlusion balloon catheter distal to the calculus; in 42, the procedure was successful. The occlusion balloon catheter permitted retrograde opacification of all systems for enhanced renal puncture. In the last 30 patients an attempt was made either to push the calculus upward mechanically or to flush it upward into the renal pelvis with carbon dioxide or dilute contrast material. This was successful in 24 of these patients. Prior overnight occlusion of the ureter by means of ureteral dilatation further facilitates dislodgment of the calculus, which was successful in 12 of 13 patients.     

Early Results of the Mau Osteotomy for Correction of Moderate to Severe Hallux Valgus: A Review of 24 Cases

In our retrospective study, we report the objective results of the Mau osteotomy in the treatment of hallux valgus. We reviewed the results of 24 cases of moderate to severe hallux valgus deformities corrected with the Mau osteotomy of the first metatarsal combined with a distal soft-tissue procedure. Follow-up was possible in 24 cases. Preoperatively the mean hallux valgus and first intermetatarsal angles were 31.3 degrees and 16.6 degrees respectively, and were corrected postoperatively to an average of 13.00 degrees+/-7.15 degrees and 9.80 degrees+/-2.43 degrees respectively (P< .001). In the sagittal plane, the first metatarsal was shortened by an average of 2.00 mm. Two (8.3%) cases had dorsal elevation of the osteotomy fragment. Complications included 3 recurrences of the deformity, 1 frank nonunion, 8 dorsal cortical nonunions, 5 cases of undercorrection, and 1 case of broken hardware that was present in the nonunion that went on to revision. There were no superficial or deep infections, and no cases of transfer metatarsalgia were noted. In this series, the use of an oblique first metatarsal osteotomy with a dorsal shelf resulted in reliable and powerful correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. Particular attention should be paid to severe IM angles and the possibility of undercorrections. Despite ambulation postoperatively, the Mau osteotomy minimized dorsal malunion and the incidence of transfer metatarsalgia. LEVEL OF CLINICAL EVIDENCE: 4.     

The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD.

The controlled treatment outcome studies that examined the efficacy of EMDR in the treatment of posttraumatic stress disorder have yielded a range of results, with the efficacy of EMDR varying across studies. The current study sought to determine if differences in outcome were related to methodological differences. The research was reviewed to identify methodological strengths, weaknesses, and empirical findings. The relationships between effect size and methodology ratings were examined, using the Gold Standard (GS) Scale (adapted from Foa & Meadows, 1997). Results indicated a significant relationship between scores on the GS Scale and effect size, with more rigorous studies according to the GS Scale reporting larger effect sizes. There was also a significant correlation between effect size and treatment fidelity. Additional methodological components not detected by the GS Scale were identified, and suggestions were made for a Revised GS Scale. We conclude by noting that methodological rigor removes noise and thereby decreases error measurement, allowing for the more accurate detection of true treatment effects in EMDR studies.     

Negative parenting behavior, combat exposure, and PTSD symptom severity. Test of a person-event interaction model.

The "personal characteristics" and "extreme event" hypotheses have been proposed as alternative explanations for the development of posttraumatic stress disorder (PTSD) among combat veterans. The person-event interaction model attempts to integrate both perspectives by hypothesizing that premilitary individual vulnerability characteristics play a greater role in influencing risk of PTSD or PTSD symptom severity at lower than at higher levels of exposure to traumatic combat stressors. Focusing on a sample of 57 Vietnam veterans undergoing inpatient treatment for diagnosed PTSD, we assessed this model by examining interactions between negative parenting behaviors in childhood (e.g., inconsistent love) and degree of combat exposure in predicting PTSD symptom severity. Hierarchical regression analyses supported the model, indicating that the father's negative parenting behaviors were more predictive of PTSD symptom severity at relatively lower levels of combat exposure. Implications of the findings for further research on multivariate, interactional models of PTSD etiology among Vietnam combat veterans are discussed.     

Linkage and association of adrenergic and dopamine receptor genes in the distal portion of the long arm of chromosome 5 with systolic blood pressure variation

Elevated blood pressure is an important risk factor for renal-, cerebro- and cardiovascular diseases. We used an efficient discordant sib-pair ascertainment scheme to investigate the impact of the distal end of the long arm of human chromosome 5 (chromosomal region 5q31.1-qter) containing genes for the alpha1B and beta2 adrenergic receptors and the dopamine receptor type 1A on variation of systolic blood pressure in young Caucasians. We measured eight highly polymorphic markers spanning this positional candidate gene-rich region in 427 individuals from 55 three-generation pedigrees containing 69 discordant sibling pairs, and calculated multipoint identity by descent (MIBD) probabilities. The results of genetic linkage and association tests indicate that the region between markers D5S2093 and D5S462 is significantly linked to one or more polymorphic genes influencing interindividual variation in systolic blood pressure levels. Since the alpha1B adrenergic receptor and dopamine receptor type 1A genes are located close to these markers, these data suggest that genetic variation in one or both of these G protein-coupled receptors, which participate in the control of vascular tone, plays an important role in influencing interindividual variation in systolic blood pressure levels.      

MMPI overreporting by Vietnam combat veterans

The MMPI-PTSD scale is the only psychometric measure that has been cross-validated on Vietnam veterans for the determination of PTSD. Despite this, there may be problems with this scale related to symptom exaggeration. Three groups of Vietnam inpatients (N = 75) were defined carefully by both clinical and actuarial methods--PTSD combat, Non-PTSD combat, and Non-combat. This study applied symptom exaggeration methods based on the MMPI obvious/subtle items and on the F scale to these groups. Results show that all the items of this scale are either obvious or neutral, that a carefully distinguished PTSD group differentially responds to these obvious and neutral items relative to other inpatient Vietnam groups, and that the F scale is exaggerated by the PTSD group. In addition, a separate analysis on an independent sample of 50 combat and 50 non-combat Vietnam veterans showed that the combat group endorsed the obvious items on selected scales by 20 T score points at higher rates than other groups. Caution in the use of the MMPI-PTSD scale is discussed.     

Treatment characteristics of psychiatric programs that correlate with patient community adjustment

This large Veterans Administration cooperative study sought to identify the ward milieu characteristics of effective psychiatric programs. It was developed as a multivariable, correlational study that involved systematic observations of program characteristics and outcome effectiveness of wards as they operated in their usual manner. Seventy-nine wards in 18 hospitals provided 11,283 patients eligible for follow-up. Eleven treatment characteristics were found to be correlated to patients' community adjustment 3 months after discharge. These characteristics were classified into five general categories: Patient-staff interaction, patient activities, medication practices, ward physical environment, and nursing staff rotation. The major conclusions are: wards do differ in their effectiveness as measured by ratings of patient posthospital adjustment; and treatment characteristics make a difference in program effectiveness as measured by patients' posthospital adjustment.     

Infection Control Citations in Nursing Homes: Compliance and Geographic Variability

ObjectivesTo report the initial compliance with new infection control regulations and geographic disparities in nursing homes (NHs) in the United States.DesignRetrospective cohort study from November 27, 2017 to November 27, 2019.Setting and ParticipantsIn total, 14,894 NHs in the continental United States comprising 26,201 inspections and 176,841 deficiencies.MethodsWe measured the cumulative incidence of receiving F880: Infection Prevention and Control deficiencies, geographic variability of F880 citations across the United States, and the scope and severity of the infection control deficiencies.ResultsA total of 6164 NHs (41%) in the continental United States received 1 deficiency for F880, and 2300 NHs (15%) were cited more than once during the 2-year period. Geographic variation was evident for F880 deficiencies, ranging from 20% of NHs in North Carolina to 79% of NHs in West Virginia. Between 0% (Vermont) and 33% (Michigan) of states’ NHs were cited multiple times over 2 years. Facilities receiving 2 or more F880 deficiencies were more reliant on Medicaid, for-profit, and served more acute residents. Infection Prevention and Control deficiencies were of similar severity but of greater scope in NHs that were cited multiple times.Conclusions and ImplicationsAs the coronavirus disease 2019 pandemic challenges hospitals with an increased surge of patients from the community, NHs will be asked to accept convalescing patients who were previously infected with the virus. NHs will need to rely on infection control practices to mitigate the effects of the virus in their facilities. Particular attention to NHs that have fared poorly with repeat infection control practices deficiencies might be a good first step to improving care overall and preventing downstream morbidity and mortality among the highest-risk patients.