5 results
Impact of severity of personality disorder on the outcome of depression
- Brendan D. Kelly, Ula A. Nur, Peter Tyrer, Patricia Casey
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- Journal:
- European Psychiatry / Volume 24 / Issue 5 / June 2009
- Published online by Cambridge University Press:
- 16 April 2020, pp. 322-326
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The influence of severity of personality disorder on outcome of depression is unclear. Four hundred and ten patients with depression in 9 urban and rural communities in Finland, Ireland, Norway, Spain and the United Kingdom, were randomised to individual problem-solving treatment (n = 121), group sessions on depression prevention (n = 106) or treatment as usual (n = 183). Depressive symptoms were recorded at baseline, 6 and 12 months. Personality assessment was performed using the Personality Assessment Schedule and analysed by severity (no personality disorder, personality difficulty, simple personality disorder, complex personality disorder). Complete personality assessments were performed on 301 individuals of whom 49.8% had no personality disorder; 19.3% had personality difficulties; 13.0% had simple personality disorder; and 17.9% had complex personality disorder. Severity of personality disorder was correlated with Beck Depression Inventory (BDI) scores at baseline (Spearman's r = 0.21; p < 0.001), 6 months (r = 0.14; p = 0.02) and 12 months (r = 0.21; p = 0.001). On multi-variable analysis, BDI at baseline (p < 0.001) and type of treatment offered (individual therapy, group therapy, treatment as usual) (p = 0.01) were significant independent predictors of BDI at 6 months. BDI at baseline was the sole significant independent predictor of BDI at 12 months (p < 0.001). There was no interaction between personality disorder and treatment type for depression.
While multi-variable analyses indicate that depressive symptoms at baseline are the strongest predictor of depressive symptoms at 6 and 12 months, the strong correlations between severity of personality disorder and depressive symptoms make it difficult to establish the independent effect of personality disorder on outcome of depression.
Optimising outcome assessment of voice interventions, II: sensitivity to change of self-reported and observer-rated measures
- I N Steen, K MacKenzie, P N Carding, A Webb, I J Deary, J A Wilson
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- Journal:
- The Journal of Laryngology & Otology / Volume 122 / Issue 1 / January 2008
- Published online by Cambridge University Press:
- 14 May 2007, pp. 46-51
- Print publication:
- January 2008
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Objectives:
A wide range of well validated instruments is now available to assess voice quality and voice-related quality of life, but comparative studies of the responsiveness to change of these measures are lacking. The aim of this study was to assess the responsiveness to change of a range of different measures, following voice therapy and surgery.
Design:Longitudinal, cohort comparison study.
Setting:Two UK voice clinics.
Participants:One hundred and forty-four patients referred for treatment of benign voice disorders, 90 undergoing voice therapy and 54 undergoing laryngeal microsurgery.
Main outcome measures:Three measures of self-reported voice quality (the vocal performance questionnaire, the voice handicap index and the voice symptom scale), plus the short form 36 (SF 36) general health status measure and the hospital anxiety and depression score. Perceptual, observer-rated analysis of voice quality was performed using the grade–roughness–breathiness–asthenia–strain scale. We compared the effect sizes (i.e. responsiveness to change) of the principal subscales of all measures before and after voice therapy or phonosurgery.
Results:All three self-reported voice measures had large effect sizes following either voice therapy or surgery. Outcomes were similar in both treatment groups. The effect sizes for the observer-rated grade–roughness–breathiness–asthenia–strain scale scores were smaller, although still moderate. The roughness subscale in particular showed little change after therapy or surgery. Only small effects were observed in general health and mood measures.
Conclusion:The results suggest that the use of a voice-specific questionnaire is essential for assessing the effectiveness of voice interventions. All three self-reported measures tested were capable of detecting change, and scores were highly correlated. On the basis of this evaluation of different measures' sensitivities to change, there is no strong evidence to favour either the vocal performance questionnaire, the voice handicap index or the voice symptom scale.
Optimising outcome assessment of voice interventions, I: reliability and validity of three self-reported scales
- A L Webb, P N Carding, I J Deary, K MacKenzie, I N Steen, J A Wilson
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- Journal:
- The Journal of Laryngology & Otology / Volume 121 / Issue 8 / August 2007
- Published online by Cambridge University Press:
- 29 March 2007, pp. 763-767
- Print publication:
- August 2007
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Background:
There is an increasing choice of voice outcome research tools, but good comparative data are lacking.
Objective:To evaluate the reliability and validity of three voice-specific, self-reported scales.
Design:Longitudinal, cohort comparison study.
Setting:Two UK voice clinics: the Freeman Hospital, Newcastle upon Tyne, and the Glasgow Royal Infirmary.
Participants:One hundred and eighty-one patients presenting with dysphonia.
Main outcome measures:All patients completed the vocal performance questionnaire, the voice handicap index and the voice symptom scale. For comparison, each patient's voice was recorded and assessed perceptually using the grade–roughness–breathiness–aesthenia–strain scale. The reliability and validity of the three self-reported vocal performance measures were assessed in all subjects, while 50 completed the questionnaires again to assess repeatability.
Results:The results of the 170 participants with completed data sets showed that all three questionnaires had high levels of internal consistency (Cronbach's alpha = 0.81–0.95) and repeatability (voice handicap index = 0.83; vocal performance questionnaire = 0.75; voice symptom scale = 0.63). Concurrent and criterion validity were also good, although, of the grade–roughness–breathiness–aesthenia–strain subscales, roughness was the least well correlated with the self-reported measures.
Conclusion:The vocal performance questionnaire, the voice handicap index and the voice symptom scale are all reliable and valid instruments for measuring the patient-perceived impact of a voice disorder.
Serum creatinine and perioperative outcome – a matched-pairs approach using computerised anaesthesia records
- M. G. Dehne, A. Junger, B. Hartmann, L. Quinzio, R. Röhrig, M. Benson, G. Hempelmann
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- Journal:
- European Journal of Anaesthesiology / Volume 22 / Issue 2 / February 2005
- Published online by Cambridge University Press:
- 13 April 2005, pp. 89-95
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- February 2005
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Summary
Background and objective: A study was designed to utilise the resources of our computerised anaesthesia record keeping system to assess the attributable effects of increased preoperative creatinine (>1.3 mg dL−1) on outcome in patients undergoing non-cardiac surgery.
Methods: This retrospective study was based on data sets of 58 458 patients recorded with a computerised anaesthesia record keeping system over a period of 4 yr at a tertiary care university hospital. Cases were defined as patients with a preoperative creatinine >1.3 mg dL−1; controls (creatinine ≤1.3 mg dL−1) were selected and automatically matched according to several parameters (ASA physical status, high risk and urgency of surgery, age and gender) in a stepwise fashion. Main outcome measures were hospital mortality and the incidence of intraoperative cardiovascular events.
Results: Three-thousand-and-twenty-eight patients (5.2%) had preoperative creatinine values >1.3 mg dL−1. Matching was successful for 54.5% of the cases, leading to 1649 cases (mean creatinine 3.3 ± 2.2 mg dL−1) and 1649 controls (1.0 ± 0.2 mg dL−1). The crude mortality rates for the cases and matched controls were 2.2% (n = 36) and 0.9% (n = 15), respectively (P = 0.003). Intraoperative cardiovascular events were found in 30.1% of the patients (n = 496) and in 28.3% of the matched controls (n = 466; P = 0.25, power = 0.46). Using logistic regression analyses a significant association between preoperative increased creatinine and hospital mortality was found (odds ratio 2.62; 95% confidence interval [1.39; 4.93]).
Conclusions: An increased preoperative serum creatinine in patients undergoing non-cardiac surgery is associated with an increased perioperative risk, but not with a higher incidence of intraoperative cardiovascular events.
Anaesthetic management and outcome in right-lobe living liver-donor surgery
- G. Cammu, R. Troisi, O. Cuomo, B. de Hemptinne, E. Di Florio, E. Mortier
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- Journal:
- European Journal of Anaesthesiology / Volume 19 / Issue 2 / February 2002
- Published online by Cambridge University Press:
- 16 August 2006, pp. 93-98
- Print publication:
- February 2002
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Background and objective: We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation.
Methods: After preoperative psychiatric evaluation, eight ASA I–II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8–1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma – four lesions, involving both liver lobes – of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h−1 and sufentanil 0.3 μg kg−1 intravenously; cisatracurium, 0.15 mg kg−1, was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1–1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (< 80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived.
Results: Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525–780) min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5–25) h after arrival. The estimated blood loss was 967 (550–1600) mL. No homologous blood was administered; five donors received autologous blood,intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1472 (700–3100)mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately postoperative haemoglobin concentration averaged 13.6 (9.8–15.6) and 10.5 (6.9–13.0) g dL−1 respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4–15.1) g dL−1. The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1–3) days. The hospital stay was 13 (7–17) days. There was no morbidity or mortality.
Conclusions: The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.