What can we learn from consumer studies and qualitative research in the treatment of eating disorders?

The aim of this paper is to review all qualitative research and questionnaire surveys with people who have experienced an eating disorder or received treatment for it. Studies were identified on PubMed and PsychInfo. Twenty-three studies were identified and key findings are reviewed. Support and understanding are critical aspects of treatment perceived as helpful. Empathic relationships, whether professional or non-professional, were reported as essential to recovery. Psychological interventions (counselling and therapy) are the most popular and perceived as the most helpful. Many patients report that "medical interventions" were unhelpful. Interventions which focus exclusively on weight are reported negatively and many studies identify the importance of addressing wider issues than food and weight in treatment.

Does concurrent psychopathology at presentation influence response to treatment for bulimia nervosa?

Pub Med and Psych Lit were searched using the key terms 'outcome' and 'bulimia nervosa' for papers on outcome and bulimia nervosa (BN). The studies which examined any aspect of psychopathology are included and the findings reviewed. No robust findings emerged. This paper reviews the methodological problems that beset this area, and then examines in detail the relationship between other psychological dysfunctions and psychiatric co-morbidity and treatment outcome for BN. The psychological variables that most probably predict poorer outcome are low self-esteem, and low satisfaction with or perceived quality of friendships. With regard to psychiatric co-morbidity, there is no consistent relationship with any Axis I disorder. Most of the studies assessing Axis II dysfunction show that borderline symptom severity or cluster B personality disorder can impair outcome. The implications for clinical practice are discussed and directions for future research suggested.

Working with older people with communication difficulties: an evaluation of care worker training

Studies suggest that a high proportion of older people in residential and nursing care have communication difficulties and there is some awareness of the need for staff training to allow effective communication to be achieved. This paper describes part of the evaluation of a one-day training package aimed at enabling care staff to communicate with older people who have a variety of communication difficulties. Care staff from four partner agencies completed questionnaires pre- and post-training, addressing contact with people with communication disorders, previous training on communication, knowledge about communication, attitudes towards communication problems and strategies to help communication with people who have communication difficulties. Positive gains were found in attitudes and self-perceptions of knowledge and competence, as well as in appropriate citations of strategies to enhance communication. The findings are discussed with reference to the need for enhanced communication skills in care workers engendered by current developments in care policy.

Learning for interprofessional and inter-agency practice in the new social work curriculum: evidence from an earlier research study

The UK Government's consultation document, A Quality Strategy for Social Care (2000) seeks consistency and excellence in care services and enhanced service partnerships. It states that this requires improved training for social workers and raises the prospect of a new social work curriculum in which learning for interprofessional and inter-agency practice will be strengthened. The document stresses the importance of evidence in decision-making in social care and this principle applies equally to training but there are few recent research findings on interprofessional and inter-agency learning in the social work curriculum. There are, however, findings from an earlier study which contributed to the mid-1990s review of the Diploma in Social Work but which have not previously been published in the mainstream media. These findings are reported and show: the kinds of organisations and professions with whom social work practitioners were in close contact in their jobs; the importance attached by social workers to defined skills in working with them; the perceived usefulness of training in developing relevant knowledge and skills; perceptions of shared training; and marked differences of learning experience reported by practitioners who had taken different training courses. Each set of findings is described and used as the basis of questions for the new social work curriculum.

Serum complement activation in congestive heart failure

BACKGROUND

Although activation of the complement system in myocardial infarction and cardiopulmonary bypass has been shown to contribute to myocardial injury, its role in congestive heart failure (CHF) is unknown. The purpose of this study was to determine the presence of terminal complement activation and its relation to clinical outcomes in patients with CHF.

METHODS

We measured serum levels of the terminal complement complex C5b-9 in 36 patients with symptomatic heart failure and left ventricular ejection fraction <40%. We compared the serum C5b-9 levels of these patients with CHF with a group of 12 age-matched control patients. Combined clinical outcomes (death, urgent heart transplantation, or hospitalization with worsening heart failure) at 6 months were determined.

RESULTS

The serum C5b-9 [median (25th to 75th percentiles)] levels in 36 patients with CHF [101.5 ng/mL (40 to 164)] were significantly (P =.003) higher than in the 12 control patients [36.5 ng/mL (22 to 50)]. Significantly more of the patients with CHF with the highest levels of C5b-9 (highest 50th percentile) had New York Heart Association class IV symptoms (67% vs 33%; P =.04) and adverse clinical outcomes by 6 months (56% vs 17%; P =.02) compared with the patients with CHF with lower levels (lowest 50th percentile).

CONCLUSIONS

We have described a significant elevation in circulating C5b-9, the terminal complement complex, in patients with symptomatic heart failure and have observed an association between high levels of C5b-9 and near-term adverse events.

Symptomatic splenic hamartoma with renal, cutaneous, and hematological abnormalities

BACKGROUND

There is a rare association between splenic hamartomas and hematological abnormalities with, to our knowledge, only 24 reported cases in the English literature.

PATIENTS AND METHODS

We report a case of a splenic hamartoma in a 14-year-old boy associated with membranoproliferative glomerulonephritis, multiple lobular capillary hemangiomas of the skin, hypertension, and anemia. Following imaging with ultrasonography, MRI, and nuclear scans, a hamartoma was suspected, but malignancy could not be excluded. The lesion was removed by partial splenectomy, and pathological examination confirmed the presence of a red pulp splenic hamartoma.

RESULTS

The renal, hematological, and dermatological abnormalities resolved following removal of the splenic hamartoma. This is the first reported case of a splenic hamartoma associated with renal, cutaneous, and hematological abnormalities and only the second reported case of a symptomatic splenic hamartoma treated by partial splenectomy.

Patterns of interactions in multidisciplinary child protection teams in New Jersey

OBJECTIVE

The objective of this study was to gain an understanding of how multidisciplinary team members in child protection worked together within the team, meeting to provide assessments of, and services to, children and families.

METHOD

Fifteen multidisciplinary child-protection teams in New Jersey were observed during one meeting of each team. The interaction among team members was recorded and analyzed using a structured observation method, Bales' Interaction Process Analysis.

RESULTS

There was a wide variation in participation among team members, with some contributing nothing to the meeting and others contributing a great deal. In some teams, participation by members was more equal than others. Some professional groups and agencies contributed very little to any meeting while others contributed a great deal to many meetings.

CONCLUSIONS

Professionals are members of multidisciplinary teams because they are expected to contribute to the investigation of child maltreatment cases and to the planning for further work with cases. However, the findings from this study suggest that there is a considerable degree of inequality in levels of participation in multidisciplinary meetings. It is particularly noticeable that staff from the prosecutor's offices participate in every meeting and either the agency as a whole or individual members of it dominate many of the meetings.

Development of a model for bioresorbability of bioceramic microparticles

Over the past decade, numerous studies have implicated wear particle debris, generated by everyday wear or ceramic implants, as the essential contributors to implant failure [3,4,5,6,7]. We investigated the interactions of ceramic particles (TCP and HA) on cell viability, cell damage, and respiratory burst in a macrophage cell line (RAW 264.7) for a duration of 24, 48, and 72 hours. The results show that cellular protein levels ranged between 0.20-0.3 mg/ml for the duration of the experiment, and there was no difference detected between or among the groups (P < 0.05). Differences in MDA levels (the amount of lipid peroxides formed at the cellular membrane) were not detected at the early time points (24-48 hours). However, with time in culture there is an increase in MDA levels in all groups. There were no differences detected in nitric oxide production between TCP and the control at all phases. The amount of nitric oxide produced by cells treated with Ha decreased slightly at 24 hours. In contrast, at 48 and 72 hours there was a significant increase when compared to the control. Morphological evaluation revealed that cells treated with TCP contained irregular membrane boundaries, and appeared to have cytoplasmic extensions. Many of the macrophages consisted of large vacuoles containing TCP particles. Cells treated with HA also contained irregular cytoplasmic borders with an increase in vacuolization. At 48 hours, the morphology of all groups remained the same, and at 72 hours, many of the cells treated with TCP and HA began to lyse. Overall, RAW 264.7 macrophage cells are capable of ingesting particles of TCP and HA, and after three days in culture the cells begin to show the effects of increased retention of ceramic particles. The results of this investigation can be used as a model for the assessment of the resorbability rate of implantable devices.

Speech and language therapists as trainers: enabling care staff working with older people

A recently completed evaluation of a one day training package on communication has found evidence of a perceived need for training in both communication and communication impairment among care workers employed by health and social care agencies. This paper is a discussion of the factors that contribute to the delivery of successful workshops to front line care workers.

Multicompartment urea kinetics in well-dialyzed children

BACKGROUND

We have reported catch-up growth with hemodialysis (HD) of approximately 15 hours/week. Without an equilibrated post-treatment blood urea nitrogen, the variable-volume single-pool (VVSP) model will not account for urea rebound, inflating the estimated HD dose (K(d)t/V). A two-pool model (FVDP) predicts rebound, but requires fixed compartment volumes for the equations to be solvable in closed form, also inflating K(d)t/V.

METHODS

We developed an approximate perturbation solution (WKB method) to a variable volume, two-pool (VVDP) model. Estimated model parameters were compared with the results of equilibrated kinetic studies using measured clearance K(d) (N = 17). Once the model was validated, we re-analyzed 292 kinetic studies from our earlier cohort, which was considered well-dialyzed on the basis of growth rates (N = 12, mean annual change in height standard deviation score +0.31, mean follow-up of 26 months).

RESULTS

For the VVSP, FVDP, and VVDP models, respectively, the mean errors were (1) K(d)t/V, 0.22 +/- 0.07, 0.29 +/- 0.17, 0.06 +/- 0.07 (ANOVA, P < 0.001); (2) urea distribution volume vol/wt (%), -8.2 +/- 4.2, -9.1 +/- 3.0, -2.2 +/- 3.6 (P < 0.001). Sequential studies confirmed reproducibility, with a coefficient of variation < or = 5%. In the earlier cohort, a comparison of the VVSP and VVDP models yielded the following: (1) K(d)t/V, 1.91 +/- 0.35 vs. 1.76 +/- 0.33 (P < 0.001); (2) normalized protein catabolic rate (nPCR, g/kg/day), 1.56 +/- 0.39 vs. 1.52 +/- 0.38 (P < 0.001); and (3) K(d) (whole blood, mL/kg/min), 4.8 +/- 0.9 vs. 4.4 +/- 0.8 (P < 0.001).

CONCLUSION

This VVDP model yields reliable estimates of K(d)t/V and other kinetic parameters using standard blood urea nitrogen sampling. Analysis of patients previously characterized as well-dialyzed on the basis of growth rates clarifies the HD dose needed to sustain normal growth.

Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates

OBJECTIVE

Neuropsychological impairments are well documented in schizophrenia and are important targets of treatment. Information about the severity and pattern of deficits after treatment for the first psychotic episode and about relationships between these deficits and syndromal characteristics remains limited.

METHOD

Comprehensive neuropsychological assessments including 41 individual tests were given to 94 patients with first-episode schizophrenia after initial stabilization of psychosis and to a comparison group of 36 healthy volunteers. Profiles of neuropsychological deficits and the relationship of deficits to sex and handedness were examined. Correlations of neuropsychological deficit with a broad range of historical and clinical characteristics, including outcome, were explored.

RESULTS

Patients had a large generalized neuropsychological deficit (1.5 standard deviations compared to healthy volunteers). Patients also had, superimposed on the generalized deficit, subtle relative deficits (less than 0.5 standard deviation compared to their own average profile) in memory and executive functions. Learning/memory dysfunction best distinguished patients from healthy individuals; after accounting for this difference, only motor deficits further distinguished the groups. Patients with higher neuropsychological ability had only memory deficits, and patients with lower ability had both memory and executive deficits. No sex differences were observed beyond the normal advantage for men in motor speed. Dextral patients had less severe generalized deficit. Severity of residual symptoms was associated with greater generalized deficit. Executive and attentional deficits were most linked to global functional impairment and poor outcome.

CONCLUSIONS

The results document a large generalized deficit, and more subtle differential deficits, in clinically stabilized first-episode patients. Learning/memory deficits were observed even in patients with less severe generalized deficit, but the pattern was unlike the amnestic syndrome and probably reflects different mechanisms. Executive and attentional deficits marked the more severely disabled patients, and may portend relatively poor outcome. Failure to develop typical patterns of cerebral dominance may increase the risk for greater generalized deficit.

Coccygeal muscle injury in English Pointers (limber tail)

A condition colloquially referred to as "limber tail" and "cold tail" is familiar to people working with hunting dogs, primarily Pointers and Labrador Retrievers. The typical case consists of an adult dog that suddenly develops a flaccid tail. The tail either hangs down from the tail base or is held out horizontally for several inches from the tail base and then hangs straight down or at some degree below horizontal. Initially, the hair on the dorsal aspect of the proximal tail may be raised and dogs may resent palpation of the area 3-4 inches (8-10 cm) from the tail base. Most dogs recover spontaneously within a few days to weeks. Anecdotal reports suggest that anti-inflammatory drugs administered within 24 hours after onset hasten recovery. Less than one half of affected dogs experience a recurrence. Affected Pointers almost always have a history of prolonged cage transport, a hard workout the previous day, or exposure to cold or wet weather Most owners and trainers familiar with the condition do not seek veterinary assistance. In cases where people are not familiar with this disease, other conditions such as a fracture, spinal cord disease, impacted anal glands, or prostatic disease have been incorrectly diagnosed. We examined 4 affected Pointers and found evidence of coccygeal muscle damage, which included mild elevation of creatine kinase early after onset of clinical signs, needle electromyographic examination showing abnormal spontaneous discharges restricted to the coccygeal muscles several days after onset, and histopathologic evidence of muscle fiber damage. Specific muscle groups, namely the laterally positioned intertransversarius ventralis caudalis muscles, were affected most severely. Abnormal findings on thermography and scintigraphy further supported the diagnosis.

Recovery of human skeletal elements from a recent UK murder inquiry: preservational signatures

Factors that control bone preservation are not fully understood but generally include those that reflect "natural" taphonomic or diagenetic processes and also those reflecting anthropogenic activity. The aim of this paper is to examine whether the survival of skeletal elements from a recent UK serial murder investigation (n = 12) and three archaeological cemetery sites from England (n = 112, 95, 182; Roman to early-medieval), share a similar recovery signature. Examination of this data demonstrates that even when clear evidence of traumatic and perimortem dismemberment exists within an assemblage, the distribution of missing elements can be almost identical to archaeological material buried in normal attrition cemeteries. Given that these preservational signatures are so similar, it is concluded that careful observation of bone surfaces is necessary to confidently interpret bone loss, particularly where dismemberment and/or element excision is suggested by the non-anatomical position of the skeleton within the grave. Where postmortem excision of bone is suspected, careful examination of contiguous bone surfaces, both macroscopic and microscopic, is suggested to detect fine cutmark lesions indicative of anthropogenic excision. Without this evidence other preservational factors must be considered both taphonomic and diagenetic.

A homolog of the fungal nuclear migration gene nudC is involved in normal and malignant human hematopoiesis

The filamentous fungus Aspergillus nidulans nudC gene has an essential function in movement of nuclei following mitosis and is required for normal colony growth. Here, the molecular cloning and role in hematopoiesis of a human gene (designated HnudC) homologous to A. nidulans nudC is reported. The amino terminus of the larger human protein (HNUDC = 45 kDa) does not overlap with A. nidulans NUDC (22 kDa). However, NUDC and the C-terminal 94 amino acids of HNUDC are 67% identical. The C-terminal region of the HnudC gene fully complements the A. nidulans temperature-sensitive nudC3 mutation, suggesting that nudC has an essential function in cell growth that is conserved from filamentous fungi to humans. In initial studies, HNUDC levels were much higher in erythroid precursors compared to most other human tissues. Therefore, the potential role of HnudC in hematopoiesis was explored. In normal human bone marrow, HNUDC protein and mRNA are highly expressed in early myeloid and erythroid precursors and decline as these cells terminally differentiate. To determine whether hematopoietic growth factors induce HnudC expression, TF-1 cells were stimulated by granulocyte-macrophage colony-stimulating factor. This induced a significant increase in HNUDC protein and HnudC mRNA, suggesting that enhancement of HnudC expression in response to growth factor stimulation may be mediated at the transcription level. Furthermore, HNUDC was significantly enhanced in lysates of bone marrow aspirates from patients with acute myelogenous and acute lymphoblastic leukemia compared to aspirates from normal controls, suggesting that HnudC is involved in malignant hematopoietic cell growth as well. These data demonstrate that HNUDC is highly expressed in normal and malignant human hematopoietic precursors and suggest it is of functional importance in the proliferation of these cells.

Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance

Growth of children during maintenance hemodialysis has been reported to be uniformly poor, with a mean annual loss of 0.4 to 0.8 SD in height. We adopted an intensive program of closely monitored energy and protein intake with dialysis urea clearances exceeding conventional recommendations. Twelve prepubertal or early pubertal children (aged 7 months to 14 years) were monitored for an average of 2.2 years (range 4 to 81 months) while receiving maintenance hemodialysis. These children received an average of 90.6% and 155.9% of their recommended energy and protein nutritional intake, respectively. With a prescribed urea clearance of 5 mL/kg/min, we achieved a mean single treatment urea clearance normalized for total body water of 2.00, a urea reduction ratio of 84.7%, and an average time of hemodialysis of 14.8 h/wk, all well beyond current guidelines. Over the course of dialysis treatment, the improvement in height SD score was+0.31 SD/y (+0.32 excluding the 2 children treated with recombinant human growth hormone). Normal growth was achieved without overt obesity and was associated with normal pubertal growth spurt. These findings suggest that the combination of increased dialysis and adequate nutrition can promote normal growth in children treated with long-term hemodialysis.