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The assessment of outcomes after treatment with antipsychotic medication is fundamental to clinical care and research. The Routine Assessment of Patient Progress (RAPP) is a reliable multidimensional scale that employs nurses' ratings of symptoms and functioning in psychiatric inpatients. The present study sought to extend validity evidence for the RAPP by examining its ability to reflect changes associated with treatment by antipsychotic medications. The use of a different sample in this study also provided the opportunity to replicate earlier validity data collected on the original set of patients. Ninety-seven separate trials were conducted, involving 65 consecutive admissions to a unit that specializes in the assessment and treatment of patients with long standing severe psychiatric disorders. The RAPP, along with the Positive and Negative Syndrome Scale and global measures of severity, were administered at baseline and at the end of each trial. Both factor scores and clinically-derived subscales were analysed for sensitivity to change. Patients were globally rated as improved, unchanged or worsened at the end of the medication trial. Results indicated that the RAPP factor, clinical scale and total scores compared favourably to other outcome measures in patients rated as improved or worse. In patients rated as unchanged, RAPP scores displayed significantly less change than did the PANSS scores. These findings support the validity of the RAPP as an outcome measure in treatment trials. [ABSTRACT FROM AUTHOR]

Social support, depressive symptoms, and three methods of coping were assessed in 45 patients with Parkinson's disease (PD) and 24 comparably disabled controls. The PD subjects employed significantly fewer cognitive and behavioral coping strategies compared with the controls. Fewer depressive symptoms were related to increased cognitive coping in PD sub jects. Behavioral coping strategies were associated with lesser depression among controls. Avoidance coping methods showed a marginally significant positive association with depressive symptoms in PD subjects. Social support was related to the significant coping predictors in each group, but was not related to depressive symptoms. Although correlational, these results might suggest that active (cognitive and behavioral) coping strategies are superior to avoidance strategies in attenuating the affective distress expected from chronic deteriorative illnesses. [ABSTRACT FROM PUBLISHER]

A high incidence of depressive symptoms has been observed in patients with Parkinson's disease (PD). PD involves a loss of central monoamines, and a decrease of monoamines has been implicated in depression; therefore, it is possible that depressive symptoms in PD result from the loss of endogenous neurotransmitters. However, it is equally possible that depressive symptoms represent a reaction to the chronic disabling course of PD. By comparing depressive symptoms in PD patients to those in matched patients with other chronic disabling diseases not involving a loss of central monoamines, it may be possible to decide between these alternatives. Thus, depressive symptoms were assessed in 45 patients with PD and 24 disabled controls that did not differ from the PD subjects on a measure of functional disability. Results showed that PD subjects obtained significantly higher total scores on the Beck Depression Inventory (BDI) than controls. PD subjects scored significantly higher than controls on BDI items grouped to reflect cognitive-affective and somatic depressive symptoms. The BDI scores of PD subjects were not reliably related to age, sex, duration of PD, or clinical ratings of PD symptom severity or functional disability. Self-rated disability and the number of recent medical problems were the greatest predictors of depressive symptoms. These findings supported the hypothesis that depressive symptoms in PD may not represent solely a reaction to disability. (J Geriatr Psychiatry Neurol 1989; 2:3-9). [ABSTRACT FROM PUBLISHER]

Organic contamination is starting to play an important role in the production and quality control of Si wafers. For the traceability of the source of contamination, information on the chemical binding conditions is very valuable. A near edge X-ray absorption fine structure (NEXAFS) investigation is the natural development of total reflection X-ray fluorescence (TXRF) analysis of the wafer surfaces able to solve the problem of speciation. The plane grating monochromator beamline for undulator radiation of the Physikalisch-Technische Bundesanstalt at the electron storage ring BESSY II, which provides photon energies between 30 eV and 1.9 keV for the specimen excitation, is an ideal excitation source for TXRF-NEXAFS experiments that require a high resolving power and a sufficient photon flux for trace analysis of low Z elements. The contaminants have been diluted and deposited as droplets on wafer pieces thoroughly cleaned after the cutting. The K edges of C, N, O have been examined. Some discrepancies have been found in the analysis of the same compounds in two different beamtimes; molecular orientation is pointed to as the cause for the difference in magnitude of the resonances. The unintentional contamination has been identified as mainly composed of aliphatic chains. [Copyright &y& Elsevier]

Competing Interests: The authors have no conflict of interest or financial disclosures to declare., (© 2023 Aerzteverlag medinfo AG.)

For cochlear implants (CI) a final position of the electrode array (EA) along the inner wall of the spirally shaped cochlea is considered to be beneficial because it results in a closer proximity to the auditory nerve fibers. A shape memory effect (SME) could facilitate such shift of the EA toward the cochlear inner wall, but its implementation remains to be solved. The current study presents an EA prototype featuring the SME with minute adjustments of the material properties of Nitinol, a shape memory alloy, in combination with a suitable cooling strategy to prevent premature curling. Ten samples were successfully inserted by a CI surgeon into an artificial cochlear model submerged into a temperature-controllable water bath to simulate temporary hypothermia of the inner ear (31°C). Gentle insertions were possible, with an average insertion speed of 0.81 ± 0.14 mm/s. After recovery of body temperature, the desired position shift toward the modiolus was observed in all trials. Angular insertion depth increased by approximately 81.8° ± 23.4°. We demonstrate for the first time that using the body temperature responsive SME for perimodiolar EA positioning is feasible and does not impede a gentle surgical insertion., (© 2022 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals LLC.)

Importance: Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial., Objective: To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity., Design, Setting, and Participants: This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022., Intervention: After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning., Main Outcomes and Measures: Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals., Results: There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time., Conclusions and Relevance: In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge., Trial Registration: isrctn.org Identifier: ISRCTN83274049.

Background: The alfapump ® is an implantable class III medical device that pumps ascitic fluid from the peritoneal space to the urinary bladder from where it is excreted. The pump reduces or abrogates the need for repeated paracentesis in patients with recurrent or refractory ascites., Aims: To improve outcomes for alfapump ® implantation and pre- and post-implant patient management in both clinical trial and real-world settings by development of consensus recommendations., Methods: The alfapump ® working group consisting of hepatologists and surgeons with extensive experience in implantation of the alfapump ® and patient management met on two occasions: (1) to determine the key areas where recommendations should be made; and (2) to discuss the experiences of the working group within those areas and formulate draft statements. Developed statements were submitted to the group and consensus sought on relevance and wording through a collaborative iterative approach in order to consolidate the recommendations into consensus statements. Only recommendations agreed upon unanimously were included., Results: Twenty-three consensus recommendations were developed in the areas of pre-implantation procedure, (three statements), surgical implant procedure (11 statements), immediate post-implant care (three statements) and long-term management (six statements)., Conclusions: The consensus statements are a valuable reference resource for physicians managing patients with the alfapump ® and for those considering management strategies for patients with refractory ascites., (© 2022. The Author(s).)

Background: A comprehensive in-hospital patient management with reasonable and economic resource allocation is arguably the major challenge of health-care systems worldwide, especially in elderly, frail, and polymorbid patients. The need for patient management tools to improve the transition process and allocation of health care resources in routine clinical care particularly for the inpatient setting is obvious. To address these issues, a large prospective trial is warranted., Methods: The "Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay" (In-HospiTOOL) study is an investigator-initiated, multicenter effectiveness trial to compare the effects of a novel in-hospital management tool on length of hospital stay, readmission rate, quality of care, and other clinical outcomes using a time-series model. The study aims to include approximately 35`000 polymorbid medical patients over an 18-month period, divided in an observation, implementation, and intervention phase. Detailed data on treatment and outcome of polymorbid medical patients during the in-hospital stay and after 30 days will be gathered to investigate differences in resource use, inter-professional collaborations and to establish representative benchmarking data to promote measurement and display of quality of care data across seven Swiss hospitals. The trial will inform whether the "In-HospiTOOL" optimizes inter-professional collaboration and thereby reduces length of hospital stay without harming subjective and objective patient-oriented outcome markers., Discussion: Many of the current quality-mirroring tools do not reflect the real need and use of resources, especially in polymorbid and elderly patients. In addition, a validated tool for optimization of patient transition and discharge processes is still missing. The proposed multicenter effectiveness trial has potential to improve interprofessional collaboration and optimizes resource allocation from hospital admission to discharge. The results will enable inter-hospital comparison of transition processes and accomplish a benchmarking for inpatient care quality.

Currently, a lot of research effort in polymer analysis by liquid chromatographic techniques, including size exclusion chromatography (SEC), polymer HPLC or liquid chromatography at critical conditions, is done aiming to improve separation performance. In this study, novel gradient protocols were investigated primarily based on gradient polymer elution chromatography (GPEC). Starting with linear gradients and stepwise gradients a new periodic saw tooth gradient profile was developed and optimized. Optimum settings for the saw tooth gradient design were evaluated by design of experiments (DoE) based on Taguchi's methodology for various types of stationary phases. The gain of peak resolution was dependent on the effective gradient step height. The optimized protocol enabled high-resolution polymer HPLC (HRP-HPLC) separations with common HPLC instruments. The quality of separation was evaluated by heart-cut fraction collection of HRP-HPLC and subsequent determination of the individual fractions by SEC or MALDI-ToF mass spectrometry. Finally, different types of polymers, such as PVC, PDMS, PMMA, or PPG, were studied with the new method and a universal applicability was shown., (Copyright © 2018. Published by Elsevier B.V.)

The adaption of an parallel-path poly(tetrafluoroethylene)(PTFE) ICP-nebulizer to an evaporative light scattering detector (ELSD) was realized. This was done by substituting the originally installed concentric glass nebulizer of the ELSD. The performance of both nebulizers was compared regarding nebulizer temperature, evaporator temperature, flow rate of nebulizing gas and flow rate of mobile phase of different solvents using caffeine and poly(dimethylsiloxane) (PDMS) as analytes. Both nebulizers showed similar performances but for the parallel-path PTFE nebulizer the performance was considerably better at low LC flow rates and the nebulizer lifetime was substantially increased. In general, for both nebulizers the highest sensitivity was obtained by applying the lowest possible evaporator temperature in combination with the highest possible nebulizer temperature at preferably low gas flow rates. Besides the optimization of detector parameters, response factors for various PDMS oligomers were determined and the dependency of the detector signal on molar mass of the analytes was studied. The significant improvement regarding long-term stability made the modified ELSD much more robust and saved time and money by reducing the maintenance efforts. Thus, especially in polymer HPLC, associated with a complex matrix situation, the PTFE-based parallel-path nebulizer exhibits attractive characteristics for analytical studies of polymers., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The current study aimed at developing and conducting a preliminary validation a novel social functioning measure for people with early psychosis. The First Episode Social Functioning Scale (FESFS) was developed to cover many domains specific to this population in their contemporary reality. The self-report version of the FESFS was administered to 203 individuals receiving services in first episode clinics. Scores of the GAF, SOFAS, Social Functioning Scale and BPRS were also obtained for parts of the sample to calculate convergent and discriminant validity. A subgroup also answered the FESFS at several time points during treatment in order to determine sensibility to change. Principal component factor analyses and internal consistency analyses revealed the following nine factors with alphas ranging from 0.63 to 0.80: Friendships and social activities, Independent living skills, Interacting with people, Family, Intimacy, Relationships and social activities at work, Work abilities, Relationships and social activities at school, Educational abilities. Convergent and discriminant validity were demonstrated, as well as sensitivity to change. Clinical and research utility of the FESFS are discussed., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

It is well known that the mixing ratio affects the molar mass distribution of synthetic polymers determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Surely, the molar mixing ratio determines whether a mass spectrum will be obtained or not. However, depending on the mass range, several effects such as multimer formation occur, which might be a source of errors in molar mass distribution calculations. In this study, the effect of mixing ratio was investigated for several synthetic polymers, including polystyrene (PS), poly(dimethylsiloxane) (PDMS), poly(ethylene glycol) (PEG), and poly(methyl methacrylate) (PMMA) using statistical designs of experiments. The 2(3) full factorial design was found to be suitable in the study of more than 1000 samples. The obtained MALDI mass spectra as well as the ANOVA statistics show that the mixing ratio affects the molar mass distribution. The optimal mixing ratio for a defined synthetic polymer depends on the studied combination (matrix, cationization reagent, solvent)., (Copyright © 2010 American Society for Mass Spectrometry. Published by Elsevier Inc. All rights reserved.)

In recent years, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has become a powerful tool for the study of synthetic polymers although its mechanism is still not understood in detail. Sample preparation plays the key role in obtaining reliable MALDI mass spectra, in particular, the proper choice of matrix, cationization reagent, and solvent. There is still no general sample preparation protocol for MALDI analysis of synthetic polymers. For known synthetic polymers, such as polystyrenes and other frequently investigated polymers, application tables in review articles might be a guide for selecting a MALDI matrix, cationization reagent, and solvent. For unknown polymers (polymers which were not analyzed by MALDI-TOF MS before but whose structures are in part known from the manufacturing process and from NMR analysis as well), the selection of matrix and solvent is based upon the polarity-similarity principle. Chemometric methods provide a useful tool for the investigation of sample preparation because huge data sets can be evaluated in short time, that is, for extracting relevant information and for classification of samples, as well. Furthermore, chemometrics provide a suitable way for the selection of a proper matrix, cationization reagent, and solvent. In this paper, a prediction model is presented using the partial least-squares (PLS) regression. By applying the model, the suitability of appropriate (nontested) combinations (matrix, cationization reagent, solvent) can be predicted for a certain synthetic polymer based upon the investigation of a few combinations. This model may help find suitable combinations in a short time and serve as a starting point for the investigation of unknown polymers. Results are exemplary presented for polystyrene PS2850.

The principle relating to the selection of a proper matrix, cationization reagent, and solvent for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) of synthetic polymers is still a topic of research. In this work we focused on the selection of a suitable MALDI solvent. Polystyrene PS7600 and poly(ethylene glycol) PEG4820 were analyzed by MALDI-TOF MS using various solvents which were selected based on the Hansen solubility parameter system. For polystyrene (PS), dithranol was used as the matrix and silver trifluoroacetate as the cationization reagent whereas, for poly(ethylene glycol) (PEG), the combination of 2,5-dihydroxybenzoic acid and sodium trifluoroacetate was used for all experiments. When employing solvents which dissolve PS and PEG, reliable MALDI mass spectra were obtained while samples in non-solvents (solvents which are not able to dissolve the polymer) failed to provide spectra. It seems that the solubility of the matrix and the cationization reagent are less important than the polymer solubility., (2010 John Wiley & Sons, Ltd.)

Aim: The purpose of this review is to report on existing literature regarding children and adolescents younger than 16 years of age experiencing a first-episode psychiatric disturbance. Rather than providing a comprehensive list of service implications, this paper identifies some of the gaps in knowledge and practice to encourage ongoing analysis regarding better practices for early intervention for children and adolescents experiencing a first-episode psychiatric disturbance., Methods: A search was conducted to identify key evidence-based literature published from 1985 to 2007 discussing various aspects of child and youth mental health in Canada, the USA, the UK, Australia and New Zealand. The review also included 'grey' literature. Categories of information include diagnoses, pharmacological and non-pharmacological treatment, prevalence, environmental and other risk factors, and demographic variables., Results: Understanding first-episode psychiatric disturbance for patients under the age of 16 years is limited because of a scarcity of controlled studies focusing on this population. Programme evaluations are sparse, perhaps because of the small number of specialized units servicing this population. It may be helpful to enlist early intervention psychosis programmes that have been successful in assisting young people aged 16-24 in the development of better practices and care outcomes for younger age groups., Conclusions: The authors highlight information that has the potential to assist in optimizing care for those youth younger than 16 years experiencing or exhibiting signs of a first-episode psychiatric disturbance., (© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Asia Pty Ltd.)

Background and Study Aims: The reference surveillance method in patients with Barrett's esophagus is careful endoscopic observation, with targeted as well as random four-quadrant biopsies. Autofluorescence endoscopy (AFE) may make it easier to locate neoplasia. The aim of this study was to elucidate the diagnostic accuracy of surveillance with AFE-guided plus four-quadrant biopsies in comparison with the conventional approach., Patients and Methods: A total of 187 of 200 consecutive Barrett's esophagus patients who were initially enrolled (73 % male, mean age 67 years, mean Barrett's segment length 4.6 cm), who underwent endoscopy for Barrett's esophagus in four study centers, were randomly assigned to undergo either AFE-targeted biopsy followed by four-quadrant biopsies or conventional endoscopic surveillance, also including four-quadrant biopsies (study phase 1). After exclusion of patients with early cancer or high-grade dysplasia, who underwent endoscopic or surgical treatment, as well as those who declined to participate in phase 2 of the study, 130 patients remained. These patients were examined again with the alternative method after a mean of 10 weeks, using the same methods described. The main study parameter was the detection of early cancer/adenocarcinoma or high-grade dysplasia (HGD), comparing both approaches in study phase 1; the secondary study aim in phase 2 was to assess the additional value of the AFE-guided approach after conventional surveillance, and vice versa. Test accuracy measures were derived from study phase 1., Results: In study phase 1, the AFE and conventional approaches yielded adenocarcinoma/HGD rates of 12 % and 5.3 %, respectively, on a per-patient basis. With AFE, four previously unrecognized adenocarcinoma/HGD lesions were identified (4.3 % of the patients); with the conventional approach, one new lesion (1.1 %) was identified. Of the 19 adenocarcinoma/HGD lesions detected during AFE endoscopy in study phase 1, eight were visualized, while 11 were only detected using untargeted four-quadrant biopsies (sensitivity 42 %). Of the 766 biopsies classified at histology as being nonneoplastic, 58 appeared suspicious (specificity 92 %, positive predictive value 12 %, negative predictive value 98.5 %). In study phase 2, AFE detected two further lesions in addition to the initial alternative approach in 3.2 % of cases, in comparison with one lesion with conventional endoscopy (1.7 %)., Conclusions: In this referral Barrett's esophagus population with a higher prevalence of neoplastic lesions, the AFE-guided approach improved the diagnostic yield for neoplasia in comparison with the conventional approach using four-quadrant biopsies. However, AFE alone was not suitable for replacing the standard four-quadrant biopsy protocol.

Introduction: Alcohol withdrawal seizures and delirium tremens (DT) are serious complications of alcohol dependence. The prevalence of arrhythmias and other electrocardiographic (ECG) changes occurring in these clinical situations is not well studied., Methods: We performed a retrospective analysis of clinical data and ECG's from patients discharged between 1995 and 2005 with the diagnosis of DT (ICD-Code F10.4) or alcohol withdrawal seizures (F10.3). Measurement of the ECG intervals was done in lead II. The corrected QT interval (QTc) was obtained using Bazett's formula., Results: 49 patients (38 males; 11 females) with a mean age of 48 years were included in the study. 23 patients with DT and 16 with convulsions were admitted to the hospitals. Ten patients developed DT while being hospitalised for other reasons. The QTc interval was prolonged (>440 ms and >460 ms in males and females, respectively) in 31 patients (63%). Five patients (10%) developed tachyarrhythmias (two torsade de pointes, one sustained ventricular tachycardia, two supraventricular tachycardia, one atrial fibrillation). All returned to sinus rhythm after appropriate treatment., Conclusions: Tachyarrhythmias are common amongst patients with severe alcohol withdrawal syndromes. The majority of the patients had an acquired long QT syndrome which led to a torsade de pointes in two cases. No patient died in the hospital and all were discharged in sinus rhythm. Clinicians should possibly avoid QT prolonging drugs and carefully monitor the rhythm in patients with severe alcohol withdrawal syndromes.

The surface purity of silicon wafers is an important parameter to monitor for yield improvement of semiconductor devices in a production line. Surfactants are used to reduce the surface potential in order to facilitate the removal or cleaning of particles and metals. Traces of surfactant residues from the cleaning bath may still be present on the wafer surface after the final cleaning step. In this report, two capillary electrophoresis (CE) methods for the analysis of dodecylbenzene sulfonate (DBS) are developed for monitoring the surfactant residues in the wafer manufacturing process. One method is developed for the sensitive determination of all DBS homologues and isomers in one single peak. Another method is developed for the fingerprint analysis of the homologues and isomers of DBS. The Taguchi methodology was used as a systematic optimization tool for the DBS analysis by CE. The experiments were evaluated by calculating the signal-to-noise ratio values with four responses. The lowest detection limit for DBS was 15 microg/L at 95% confidence level. The percent recovery of surfactant was between 90% and 110%.

Objective: Factor analytic studies of the Positive and Negative Syndrome Scale (PANSS) have consistently isolated a factor that is frequently labeled as 'cognitive'. The present study sought to further explore the factor by examining the relationships between 4 versions of the cognitive factor and a set of neuropsychological tests., Method: Thirty-seven inpatients diagnosed with schizophrenia or schizoaffective disorder were assessed with the PANSS and neuropsychological measures., Results: Verbal intelligence and verbal memory were found to be most closely associated with cognitive factor scores. A global rating of illness severity showed greater relationships to cognitive variables than any cognitive factor., Conclusions: The PANSS cognitive factor may reflect verbal ability and memory, but is not sufficiently comprehensive to be considered as a replacement for direct assessment of cognitive functioning.

For the determination of inorganic and organic anions, the pyromellitic acid (PMA) electrolyte is widely used. The pH adjustment of the self-prepared electrolyte was very challenging to satisfy the pH of specification of pH 7.8 +/- 0.1. A modification was proposed to provide a more simple electrolyte by buffering the PMA electrolyte with triethanolamine (TEA) only instead of adjusting the pH by NaOH and TEA. Thus, the proposed electrolyte consisted of 2.25 mmol l(-1) PMA, 0.75 mmol 1(-1) hexamethonium hydroxide and 12 mmol 1(-1) TEA. The performance of the PMA electrolyte buffered by TEA only was compared to a commercial available PMA and statistically validated in accordance with the methodology of Taguchi. No statistically significant difference could be found for both electrolytes assessing the performance and detection limits of hydrodynamic, stacking and electrokinetic injection with transient isotachophoretic preconcentration as well as repeatability of migration times, peak resolutions and peak symmetries.

In the general population, low birthweight (LBW) is associated with neurological and psychological problems during childhood and adolescence. LBW may result from premature birth or poor fetal growth, and the independent effects of these two events on childhood development are not fully understood. The rate of low weight births is increased in schizophrenia and is associated with social withdrawal during childhood and an early onset of illness. However, it is unclear whether this LBW reflects poor fetal growth or premature birth, or whether these two risk factors have distinct implications for childhood functioning and age at onset of schizophrenia. Subjects included 270 patients with schizophrenia for whom a detailed history of obstetric events could be obtained. The rate of low weight births was high and was associated with poorer premorbid functioning and an earlier age at illness onset. The rate of both premature births and poor fetal growth was high relative to the normal population. Prematurity, but not poor fetal growth, was associated with premorbid social withdrawal and an early age at illness onset. Poor fetal growth, but not prematurity, was associated with low educational achievement. These results suggest that poor fetal growth and prematurity are associated with distinct patterns of childhood maladjustment in individuals who develop schizophrenia.

The areas of function affected by major mental disorders are more diverse than the list of core symptoms assessed by many psychiatric rating scales, and the cross-sectional picture obtained in mental status interviews often fails to capture important data. Information on patient function can be obtained from measures that are based on extended observation and complement symptom-focused assessments. The Routine Assessment of Patient Progress (RAPP) is a 21-item rating scale that assesses both functional and psychiatric symptoms. It is usually completed by nursing staff who have observed patients over a 1-week period. Previous research has shown it to be reliable, valid, simple to complete, and of substantial value for patient care and diagnosis. The present study sought to examine the psychometric structure of the RAPP to define what domains of symptoms and behavior it measures. RAPP scores obtained from 165 psychotic inpatients were submitted to a factor analysis. A five-factor solution was derived in which 18 of 21 RAPP items were assigned to factors. The factors were labeled aggression, positive symptoms, negative symptoms, somatization/anxiety, and organic/ disorganization. The RAPP factors were moderately correlated with conceptually similar factor scores derived from the Positive and Negative Syndrome Scale (PANSS). RAPP aggression scores were validated with an independent clinical measure of aggression. Patients who were independently rated as improved over their hospital stay showed significant improvement on all RAPP factors, and unimproved patients showed stability or deterioration on RAPP measures. The data indicate that RAPP factors assess domains of psychopathology that are moderately correlated with both global ratings and symptom-focused scales. The RAPP's sensitivity to change suggests it is a valid measure of treatment outcome that could be used in controlled trials, as well as standard care outcome evaluation.

The Clozapine Resource Centre in British Columbia is a centralized information source for all physicians wishing to prescribe clozapine and also performs back-up hematological and compliance monitoring. Laboratories fax weekly hematology results to physicians and to the center. The center enters results in a national database and compiles twice-weekly noncompliance reports; physicians are notified of abnormal results, and caregivers of noncompliance. The centralized system obviates the practice in some jurisdictions of hiring case coordinators to oversee these procedures and may reduce physician reluctance to prescribe clozapine. It improves coordination among monitoring and treatment parties and ensures better continuity of care.

The use of carbon dioxide to create a cavity for the operation of laparoscopic cholecystectomy leads to serious complications of the cardiovascular system; consequently, patients with ischaemic heart disease can be put at greater risk. For example, on reaching an intra-abdominal pressure of 15mmHg, a fall of about 35% of the static compliance was observed. Upon using the Laparolift, these influences on the respiratory system were not detected, and the rise in systemic vascular resistance usually seen with the CO2-pneumoperitoneum did not occur. From the anaesthetist's viewpoint the Laparolift was helpful in the treatment of patients with serious limitations of cardiac function.

A new instrument, the Routine Assessment of Patient Progress (RAPP), is a standardized scale with a unique format that allows trained nurses to incorporate both interview and observational data into a comprehensive assessment of psychiatric inpatients. The scale was developed to accurately document treatment effects, assist in treatment planning, and provide ancillary judgments of psychopathology that may affect diagnosis. The RAPP demonstrates satisfactory interrater reliability and internal consistency. The RAPP total score and its two subscales correlated highly, where expected, with an observation-based nursing scale, global measures, and an interview-based psychopathology scale. RAPP scores demonstrated sensitivity to change over time in patient functioning. It reliably discriminated among patients discharged to settings with varying degrees of independent living. The use of the RAPP over several years on a psychiatric inpatient unit has shown it to be a practical clinical tool that eases nurses' charting demands, helps create care plans, and facilitates interdisciplinary communication.

Objective: To study the clinical response to clozapine in patients with refractory schizophrenia., Method: Open trial of clozapine in 61 consecutively-treated patients., Results: Following clozapine, the level of function of patients was improved relative to admission (p = 0.0001) and to the highest level in the previous year (p = 0.0001). Severity of illness was decreased (p = 0.0001). Overall, 31% of the patients were classified as responders to clozapine and the responders were all identified by 32 weeks of treatment. Poor functioning in the previous year was associated with less favourable response. At a mean interval of 26 months following discharge, 72% of the patients were continuing clozapine treatment., Conclusions: This open trial of patients who were treated consecutively indicates a comparable degree of response to clozapine as observed in controlled clinical trials, and that level of functioning in the previous year was the best predictor of response.

Background: The reasons for poor treatment response in some patients with schizophrenia remain unclear. It is possible that misdiagnosis of nonschizophrenic disorders as schizophrenia could result in suboptimal pharmacotherapy in some patients., Method: To assess this possibility, 110 severely ill, chronic patients with a referral diagnosis of schizophrenia were comprehensively assessed and rediagnosed according to DSM-III-R criteria. Global Assessment of Function (GAF) and Clinical Global Impressions (CGI) ratings were made at admission and at discharge from the ward, after the implementation of individualized treatment plans., Results: The diagnosis of schizophrenia was confirmed in 80 patients (73%) and revised to another type of psychotic illness in 30 patients (27%). The GAF and CGI ratings were similar at admission in patients with confirmed and revised diagnoses. All patients improved by the time of discharge (p = .0001); however, patients with a revised diagnosis improved more than those with confirmed schizophrenia (p = .02). Patients with a revised diagnosis were less likely to require continued hospitalization on chronic care wards (p = .004). At admission, medication regimens were similar in the two groups of patients. At discharge, patients with a revised diagnosis were less likely to have received neuroleptics (p = .007) and more likely to have received antimanic drugs (p = .0002) or electroconvulsive therapy (p = .0004)., Conclusion: These findings from a clinical sample suggest that diagnostic reassessment is an important first step in the management of apparently refractory schizophrenia.

Background: Two surveys of diagnostic practices in the United States suggest that many clinicians base their diagnoses on presenting symptoms and pay little attention to course and exclusionary criteria. Failure to correctly diagnose patients may result in inappropriate therapy and poor treatment response. The purpose of the present study was to investigate diagnostic practices., Methods: We made detailed assessments of 50 consecutively admitted treatment-refractory psychotic patients and carefully applied DSM-III-R criteria., Results: Referral diagnoses were changed in 23 of the 50 patients. Diagnoses of schizophrenia and schizoaffective disorder were made far less frequently and mood disorders (bipolar disorder and major depression) were diagnosed far more frequently by our group than by referring psychiatrists. Patients whose diagnosis was changed were more likely to be given mood-stabilizing medication and tended to show more improvement than patients whose diagnosis was not changed., Conclusions: These findings raise the possibility that patients may not respond to treatment because incorrect diagnoses result in inappropriate treatment.

Two neuroleptics having different effects at dopamine receptors were administered to chronic schizophrenic inpatients to compare their therapeutic efficacy and ability to produce side effects. Haloperidol appeared to produce lower levels of psychopathology than flupenthixol but similar levels of side effects. No evidence was found that flupenthixol is specifically useful in "activating" chronic patients or in alleviating affective symptoms. Although these are preliminary results, they support the view that D2 receptors may mediate the antipsychotic effects of neuroleptic drugs.