Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services

Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services

Cohort profile : demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. Trial registration number: NCT03013595

Morphologie du fémur distal humain (analyse quantitative et applications à l'étude du genu valgum)

Les résultats des prothèses totales de genoux (PTG) sur genu valgum sont grevés d'un taux élevé de complications fémoro-patellaires. Ces complications sont pour la plupart dues au mauvais positionnement du composant fémoral des prothèses. La méconnaissance de la morphologie fémorale des genu valgum est à l'origine de ces malpositions. Les observations réalisées sur une série anatomique de genoux sains composée de 18 genu valgum et 23 genoux sans défaut d'axe nous ont permis de mettre en évidence que les condyles fémoraux latéraux des genu valgum ne présentaient pas d'hypoplasie et que la courbure frontale des diaphyses fémorales des genu valgum était moins prononcée que celle des genoux axés. Nous avons attribué le valgus fémoral des genu valgum sains que nous avons étudiés à la rectitude de leur diaphyse. L'analyse des résultats des prothèses totales de genoux sur genu valgum constitutionnel plaide en faveur de l'absence d'hypoplasie du condyle fémoral latéral des genu valgum arthrosiques et de l'application de nos conclusions en pathologie. L'intérêt de ce travail est double. Sur un plan chirurgical, nous retenons que le positionnement en rotation du composant fémoral des PTG sur genu valgum constitutionnel doit être identique à celui des genoux axés et que les gestes de détente latérale sont réaliser un plan frontal (genou en extension). Sur un plan anatomique, nous retenons l'apport des techniques de traitement d'images et de modélisation pour aboutir à une description quantifiée et donc analysable, des formes. Dans une discipline où les variations inter individuelles sont parfois difficiles à dissocier du pathologique, elles nous semblent être des outils indispensables aux recherches futures. Ces outils demandent cependant à être évalués et maîtrisés.Although the valgus slope of the femoral condyles seen in valgus knee is thought to be due to hypoplasia of the lateral femoral condyle, this fact has not been proved. The aim of this study was therefore to evaluate the morphologic features of the distal femur between neutral and valgus knee. Using a population of non-arthritic knees (18 valgus knees and 23 neutral knees), our data demonstrated that the lateral femoral condyle was thicker in valgus knees compared to neutral knees. Using image processing and automatic procedure of shape characterization, we observed that femoral shaft of valgus knees were straighter compared to neutral knees. The analysis off 13 patients who had a fixed valgus deformity of the knee with a semiconstrained total knee arthroplasty combined with advancement of the lateral collateral ligament by means of a lateral femoral condylar sliding osteotomy suggested that in fixed valgus knees, beside arthritic wear, there was no deficiency of the posterior lateral condyle of the femur. On a surgical view our study support the suggestion that in fixed valgus knees, axial positioning of the femoral component of total knee arthroplasty should be performed using the posterior condylar plane. On a more fundamental note our study questioned the concept of congenital hypoplasic femoral condyle in valgus knees. The procedure of shape characterization performed in this study open interesting perspectives for the study of individual morphologic characterization.TOURS-BU Médecine (372612103) / SudocSudocFranceF

La ligamentoplastie au Gracilis dans le traitement des instabilités fémoro-patellaires

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Récupération fonctionnelle du tibial postérieur de pieds plats acquis stade 2 traités par ostéotomie d'Evans

TOURS-BU Médecine (372612103) / SudocSudocFranceF

Ankle dorsiflexion after isolated medial versus complete proximal gastrocnemius recession: A cadaveric study

Gastrocnemius recession has been described in the treatment of gastrocnemius contracture. The aims of this study were: (1) to assess the change in ankle dorsiflexion after isolated medial gastrocnemius recession performed according to L.S. Barouk's technique; (2) to compare ankle dorsiflexion after isolated medial head with complete proximal gastrocnemius recession

Morphologie diaphysaire fémorale du genu valgum constitutionnel : étude anatomique

International audienc

Patellofemoral joint replacement, an evolving concept

Isolated patellofemoral arthritis is a rare disease, whose management is challenging and controversial. Patellofemoral joint replacement can be an effective treatment for this condition. The very concept of a patellofemoral implant has evolved throughout the years, resulting in more anatomic designs and reproducible surgical techniques. The clinical outcomes of this procedure are strictly related to surgical indications, implant design and appropriate surgical technique

Are All-Polyethylene tibial components a viable biomechanical alternative in TKAs?

Objectives: An alternative solution to fixed bearing metal-backed FMB)tibial components is the all-polyethylene (AP) monoblock tibial insert. The AP solution offers two main benefits in comparison to the FMB: it eliminates the insert-metal interface and it decreases the cost of the arthroplasty. However, this solution presents a mechanical structure that might induce different stress and strain distributions inside the tibial bone and consequent implant micro-motions. Up to now, no literature studies investigate and compare the full biomechanical behavior of the AP concept with respect to the FMB concept. For these reasons, this study aims to evaluate the stress and strain distribution, using finite element analysis, in FMB and AP tibial components for Total Knee Arthroplasty (TKA) during a high flexion motor task. Moreover, the effect of several cementing techniques and different bone qualities were also investigated.status: publishe

Are All-Polyethylene tibial components a viable biomechanical alternative in TKAs?

info:eu-repo/semantics/publishe