Personality traits and health-related quality of life in patients with mood and anxiety disorders

Background: Health-related quality of life (HRQL) is an accepted outcome measure in patients with mood and anxiety disorders. Yet, surprisingly little attention has been paid to the determinants. In this paper we test the hypothesis that it is associated with personality traits while controlling for mental disorders. Methods: A large sample of outpatients (n=640) with mood and anxiety disorders was studied. The empirically supported five factor model of normal personality traits was assessed using the NEO-FFI and includes: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Mental disorders were assessed with the CIDI, and HRQL with the SF-36. Results: Regression analyses revealed that the NEO-FFI scores, with the exception of conscientiousness, were significantly associated with SF-36 subscales and summary scores, independently from the mental disorders. The percentage of explained variance due to the personality traits was highest for the subscales Vitality (10.0%), Mental Health (13.3%) and the Mental Health Summary Score (9.5%). Furthermore, specific personality traits were related to specific SF-36 subscales. Conclusions: A low HRQL of patients with mood or anxiety disorders is not only determined by the disease or the current health but is also shaped by personality traits that are relatively stable throughout an individual’s life time. Key words: Anxiety disorders, Depressive disorder, Health-related quality of life, Personalit

Antibiotic use for irreversible pulpitis

Background Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2016. Objectives To assess the effects of systemic antibiotics for irreversible pulpitis. Search methods We searched Cochrane Oral Health's Trials Register (to 18 February 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 18 February 2019); MEDLINE Ovid (1946 to 18 February 2019); Embase Ovid (1980 to 18 February 2019); US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (searched 18 February 2019); and the World Health Organization International Clinical Trials Registry Platform (searched 18 February 2019). There were no language restrictions in the searches of the electronic databases. Selection criteria Randomised controlled trials which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. Data collection and analysis Three review authors screened studies and extracted data independently. We assessed the certainty of the evidence of included studies using GRADE. Pooling of data was not possible and a descriptive summary is presented. Main results No additional trials could be included in this update. One trial at low risk of bias evaluating oral penicillin in combination with analgesics versus placebo with analgesics, involving 40 participants was included in a former update of the review. The certainty of the evidence was rated low for the different outcomes. Our primary outcome was patient‐reported pain (intensity/duration) and pain relief. There was a close parallel distribution of the pain ratings in both the intervention (median 6.0, interquartile range (IQR) 10.5), and for placebo (median 6.0, IQR 9.5) over the seven‐day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.20 (standard deviation (SD) 6.02) in the penicillin group versus 9.60 (SD 6.34) in the placebo group; mean difference ‐0.40 (95% confidence interval (CI) ‐4.23 to 3.43; P = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.90 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI ‐1.23 to 6.13; P = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study

Paradigm shift in head and neck oncology patient management

Objective  This article describes a paradigm shift in what is considered to be good care for patients living with and after (head and neck) cancer. HNO patients often experience severe and difficult physical and psychosocial problems due to the nature and location of the disease. Many disciplines are involved in their treatment, so their voice is only one amongst many others in the decision making process. For this patient group it seems complicated to put the concept of Shared Decision Making into practice. As a step in this direction, patient reported outcomes which ask patients to select the disconcerting issues and symptoms can be used as a basis for referral, supportive care and treatment decision making. We need to provide more tailored and personalized information that is specific to individual circumstances, preferences and concerns and focuses more on the impact of treatment and access to help and support. Follow up of these patients should be concentrated on both medical and emotional aspects.  Practice implications  A shift in the way caregivers provide their information contributes to a more profound involvement of patients in treatment decisions.Output Type: Lette

Palladium-induced granulomas analysed with inductively coupled plasma mass spectrometry

Dermatology-oncolog

Coping with medical threat: An evaluation of the Threatening Medical Situations Inventory (TMSI)

The Dutch Threatening Medical Situations Inventory (TMSI) has been developed to measure cognitive confrontation ('monitoring') and cognitive avoidance ('blunting') within the domain of medical threat. It consists of four scenarios of threatening medical situations, followed by monitoring and blunting alternatives. Its psychometric properties are investigated in students (N = 123), dental (N = 80), HIV - (N = 42) and surgery patients (N = 123). For both scales, internal consistencies proved to be satisfactory. Slight sex and age effects are found. Furthermore, there is a strong situation effect: the scenario highest in controllability shows relatively high monitoring and low blunting scores. Factor structure is stable across samples and shows a good fit with the predicted factor solution. Both scales are found to converge and diverge in a theoretically meaningful manner with a variety of coping style and anxiety measures. In two samples, a sample specific stress scenario was added, but the psychometric qualities of such an extension should not be taken for granted. In an additional sample of working people (N = 48) test-retest reliability proved to be good. It is concluded that the TMSI is a useful instrument for assessing cognitive confrontation and avoidance in medical patients. An English as well as a German translation are available. Copyrigh

Performance and Tolerability of the Moisturizers Cetaphil(A (R)) and Excipial(A (R)) in Atopic Dermatitis: What is the Evidence Based on Randomized Trials?

Dermatology-oncolog

Beta2-adrenoceptor agonists for dysmenorrhoea

Background:Dysmenorrhoea is a common gynaecological complaint that can affect as many as 50% of premenopausal women, 10% of whom suffer severely enough to be rendered incapacitated for one to three days during each menstrual cycle. Primary dysmenorrhoea is where women suffer from menstrual pain but lack any pathology in their pelvic anatomy. Beta2-adrenoceptor agonists have been used in the treatment of women with primary dysmenorrhoea but their effects are unclear.Objectives:To determine the effectiveness and safety of beta2-adrenoceptor agonists in the treatment of primary dysmenorrhoea. Search methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 8), MEDLINE, EMBASE, PsycINFO and the EBM Reviews databases. The last search was on 22 August 2011.Selection criteriaRandomised controlled trials comparing beta2-adrenoceptor agonists with placebo or no treatment, each other or any other conventional treatment in women of reproductive age with primary dysmenorrhoea. Data collection and analysisTwo review authors independently assessed trial quality and extracted the data.Main results:Five trials involving 187 women with an age range of 15 to 40 years were included. Oral isoxsuprine was compared with placebo in two trials, terbutaline oral spray, ritodrine chloride and oral hydroxyphenyl-orciprenalin were compared with placebo in a further three trials. Clinical diversity in the studies in terms of the interventions being evaluated, assessments at different time points and the use of different assessment tools mitigated against pooling of outcome data across studies in order to provide a summary estimate of effect for any of the comparisons. Only one study, with unclear risk of bias, reported pain relief with a combination of isoxsuprine, acetaminophen and caffeine. None of the other studies reported any significant clinical difference in effectiveness between the intervention and placebo. Adverse effects were reported with all of these medications in up to a quarter of the total number of participants. They included nausea, vomiting, dizziness, quivering, tremor and palpitations.Authors\u27 conclusions:The evidence presented in this review was based on a few relatively small-sized studies that were categorised to have unclear to high risk of bias, which does not allow confident decision-making at present about the use of beta2-adrenoceptor agonists for dysmenorrhoea. The benefits as reported in one study should be balanced against the wide array of unacceptable side effects documented with this class of medication. We have emphasised the lack of precision and limitations in the reported data where appropriate

Harmonizing measurement of satisfaction with acne scar treatments: can we all sing the same tune?

Dermatology-oncolog