Evidence that the Two-Way Communication Checklist identifies patient-doctor needs discordance resulting in better 6-month outcome.

peer reviewedOBJECTIVE: To assess an intervention aimed at reducing patient-professional carer needs discordance. METHOD: In a group of 460 patients with schizophrenia, the Two-Way Communication Checklist (2-COM), an instrument to rate needs, was completed at baseline, 2 months and 6 months by both the patient and the professional carer, allowing for the quantification of patient-carer needs discordance. RESULTS: Reduction in patient-reported 2-COM needs in the group with low baseline needs discordance was much greater at 2 and 6 months (2 months: beta = -0.65, P < 0.001; 6 months: beta = -1.00, P < 0.001) than in the group with high baseline discordance (2 months: beta = -0.35, P < 0.001; 6 months: beta = -0.49, P < 0.001). Reduction in needs discordance between baseline and 2 months (beta = -0.07, P = 0.004) as well between 2 and 6 months (beta = -0.05, P = 0.020) was associated with greater levels of CGI clinical improvement. CONCLUSION: The fact that patient-carer needs discordance impacts negatively, and its reduction positively, on 6-month outcome suggests that systematic inventory of patient-carer views on needs is necessary

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (&lt; 5 years, 5–10 years, 10–20 years, and &gt; 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (&lt; 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs &gt; 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (&lt; 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs &gt; 20 years: 0.62), and only surgeons with &gt; 20 years of experience did not have substantial reliability on assessment 2 (&lt; 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs &gt; 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

"Take This Heart Away!": From Fear of Rejection to Post-Transplant Delirium

peer reviewe

Decline of empathy among medical students: Dehumanization or useful coping process?

International audienceObjectivesEmpathy is central in patient-physician interactions and understanding its development is decisive for education. However, scientific literature reports a striking decline of empathy among medical students during their study course. Firstly, we aimed to replicate this result on a Belgian population. Secondly, as well reported by literature, we expected higher empathy scores for women. Lastly, as central, we expected higher empathy levels for medical students than for “control” students (commercial students were used as a control group: social interactions without a curing aspect) at the beginning of their study course, suggesting that empathy drives students to select specific education fields.MethodsThrough a cross-sectional design, we assessed students from medical and commercial educations at different years of study with the Basic Empathy Scale (N = 1602). We compared: (1) empathy scores at different scholar levels for both populations; (2) scores between men and women; (3) empathy scores between medical and commercial students in their first year of study.ResultsAs expected, a significant empathy decline was displayed over time for medical students; women reported significant higher empathy scores than men; and, in their first year, medical students presented significant higher empathy scores than commercials.ConclusionsReplicating the empathy decline on several student populations is crucial, especially by using different tools. This decline is a multi-factorial process that mainly reflects self-representation changes. The empathy gender bias is a strong effect observed in several empathy-linked phenomena. Finally, empathy is not only central but also drives students to select specific education fields

Influence of heredity, sex and season on the type of episode of bipolar disorder

peer reviewedThe aim of this work was to investigate if sex, age, family history, season and hypothyroidism have any influence on the type of episodes (manic, depressive, mixed) seen in bipolar patients. This retrospective study concerns a sample of 208 patients with a diagnosis of bipolar disorder (type I or II), who were admitted in one of two psychiatric centers between July 1996 and June 2000. The sex-ratio was 2.8 females for 1 male. Sex, family history and hypothyroidism were not associated with any type of episode. A higher percentage of depressive episodes was observed in the patients who were older than 50 and the average age of depressive patients was higher than that of other patients. There was no seasonal pattern in this study and the season did not influence the type of episode. The results indicate no influence of sex, season, family history and hypothyroidism on the type of episode presented. On the opposite, age seems to favour depression episode

Pathogenic Tracks in Fatigue Syndromes

This review analyses the recent literature devoted to two related fatigue syndromes: chronic fatigue syndrome (CFS) and acute onset postviral fatigue syndrome (PVFS). The articles are grouped into five pathogenic tracks: infectious agents, immune system, skeletic muscle, hypothalamo-pituitary-adrenal (HPA) axis and psychiatric factors. Although a particular infectious agent is unlikely to be responsible for all CFS cases, evidence is shown that host-parasite relationships are modified in a large proportion of patients with chronic fatigue. Antibody titres against infectious agents are often elevated and replication of several viruses could be increased. Chronic activation of the immune system is also observed and could be due to the reactivation of persistent or latent infectious agents such as herpes viruses (i.e. HHV-6) or enteroviruses. It could also be favorised by an impaired negative feedback of the HPA axis on the immune system. A model is proposed where the abnormalities of the HPA axis are primary events and are mainly responsible for a chronic activation of the immune system which in turn induces an increased replication of several viruses under the control of cellular transcription factors. These replicating viruses together with cytokines such as TNF-alpha would secondarily induce functional disorders of muscle and several aspects of asthenia itself

Control of drug-resistant epilepsy after head injury with intravenous nimodipine.

The present report describes a young child who developed generalized epileptic seizures in the course of severe head injury. The start of epileptic seizures was associated with the occurrence of acute hyponatremia and hypoosmolality due to excessive Desmopressine administration. The seizures resistant to conventional therapy resolved completely with intravenous nimodipine infusion

Anatomical Rationale for Use of the Latissimus Dorsi Flap During the Cardiomyoplasty Operation

The cardiomyoplasty procedure involves the use of a transformed skeletal muscle to augment cardiac pump function or to substitute for the heart after parietal resection. This study of the intramuscular vascularization of latissimus dorsi was carried out in order to establish the relationship between the dominant thoracodorsal blood supply and the distal supply issued from the intercostal and lumbar arteries. This data is mandatory for the safe manipulation of the muscle flap during cardiomyoplasty. Thirty human latissimus dorsi flaps were carefully studied. We confirmed anatomically as well as angiographically previous macroscopic anatomical reports, as well as the constancy of the neurovascular pedicle. Three principal branching patterns were observed for the thoracodorsal artery. The thoracodorsal artery divides into three main tributaries in 20/30 (67%), and into two tributaries in 10/30 (33%) of the flaps observed. When three tributaries were observed, one of them was a small recurrent artery for the proximal third of the latissimus dorsi (14/20, 70%). Thus the distal vascularization is actually dependent on three principals in 6/30 (20%) and two principals in 24/30 (80%). From these two or three principals emerge several subsequent longitudinal branches (5 to 9) that have a straight course until their distal anastomoses with segmental arterial pedicles issued from intercostal and lumbar arteries. The latter ligation can thus occur without ischemic damage to the medial and distal aspect of the flap. This study emphasizes that, due to macroscopic anatomic features and systematic intramuscular vascular distribution, the latissimus dorsi is probably the most suitable muscle for the purpose of cardiomyoplasty