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Background: In some settings, specific techniques for open reduction and internal fixation are preferred based on the eminence of a surgeon or professional organization. An emphasis on technical aspects of surgery that are not proved superior and vary substantially from surgeon to surgeon can be confusing for trainees. This study applied a numerical grading of the technical aspects of tension band wire (TBW) fixation for olecranon fracture; assessed the interobserver agreement of each criterion; and measured the correlation of the technical grading and objective and subjective long-term outcomes. Materials and methods Forty observers were invited to rate the technical aspects of TBW fixation of the olecranon on 26 post-operative radiographs. The interobserver reliability of the rating was measured using the intra-class correlation coefficient. The correlation between the rating and motion, Mayo elbow performance index, and disabilities of the arm, shoulder and hand score was tested with the Spearman’s rank correlation test. Results: None of the figure-of-eight TBW constructs were considered perfect according to the numerical grading: the majority of observers found three deviations per fixation. The interobserver agreement was only fair for the total number of deviations and no correlation between the number of deviations and long-term objective and subjective outcome was found. Conclusions: A rating of the technical aspects of TBW for olecranon fractures was unreliable and did not correlate with subjective and objective outcomes. Emphasis on specific technical aspects of fixation might be confusing for trainees and could distract them from the principles of effective treatment. Level of evidence Level IV diagnostic study.

Abstract Background SPEM dysfunction is a well-known phenomenon in schizophrenia. The principal aim of the present study was to examine whether SPEM dysfunction is already observable in subjects scoring high on a specific measure of schizotypy (SSQ General Schizotypy) that was selected because of its intimate relationship with schizophrenic prodromal unfolding. Methods Applying ANOVAs, we determined the relationship of subjects' scores on SSQ General Schizotypy and eye movements elicited by targets of different speed. We also examined whether there exists an association between our schizotypy measure and pupil size. Results We found more SPEM dysfunction in subjects scoring high on SSQ General Schizotypy than in subjects scoring average on that factor, irrespective of the speed of the target. No relationship was found between baseline pupil size and General Schizotypy. Conclusion The present study provides additional evidence that SPEM dysfunction is associated with schizotypic features that precede the onset of schizophrenia and is already observable in general population subjects that show these features.

Objective: In this retrospective cohort study, we compared neonatal and maternal outcomes after exposure of different psychopharmacological classes of drugs. Both psychiatric diseases and pharmacological treatment of these are associated with lower birth weights, lower APGAR scores, and NICU admission. Therefore, we tried to rule out the role of psychotropics as if no differences were found between pharmacological classes, the lower birthweights might not be attributable to these., Method: We divided our groups in exposed to atypical antipsychotic drugs, Selective Serotonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressants (TCA), benzodiazepines, and different combinations of psychotropic drugs. The last group included SSRIs combined with benzodiazepines, methylphenidate, lithium, and classic antipsychotic drugs., Results: We used univariate regression analysis to see which factors from our rich dataset including pharmacological class, are associated with birth weight, APGAR scores, gestational age, and NICU admission. The significant associations from univariate analyses were further analyzed using ancova analysis or logistic regression where applicable., Conclusion: We found no clinically relevant differences in neonatal and maternal outcomes between the different exposed pharmacological classes. However, our dataset may have been too small to draw firm conclusions., Competing Interests: Declaration of competing interest None of the authors has anything to declare., (Copyright © 2023. Published by Elsevier Inc.)

Objectives: To gain insight in the safety of direct active rehabilitation without immobilisation in patients undergoing reverse total shoulder arthroplasty without subscapularis reattachment, measured by the occurrence of complications until 1-year follow up. Next, to explore improvement in shoulder function and in patient-reported outcome measures., Design: An international multicentre prospective cohort safety study., Setting: Patients indicated for reverse total shoulder arthroplasty, visiting the orthopaedics outpatient clinic at two hospitals in the Netherlands and one hospital in Curaçao between January 2019 and July 2021, were selected., Participants: 100 patients (68% female, mean age 74±7.0 years) undergoing unilateral primary shoulder replacement were included if: ≥50 years, diagnosed with shoulder osteoarthritis, rotator cuff arthropathy or avascular necrosis, and selected for reverse total shoulder arthroplasty. A sling was used for only 1 day, followed by a progressive active rehabilitation for ≥12 weeks with no precautions., Main Outcome Measures: Complications, range of motion and patient-reported outcome measures (Oxford Shoulder Score, Pain Numeric Rating Scale and EuroQol-5D for quality of life). Patients were evaluated preoperatively and 6 weeks, 3 months and 1 year postoperatively., Results: In total, 17 complications were registered (17.0%) including five (5.0%) categorised as potentially related to the rehabilitation strategy: one dislocation, one acromion fracture and three cases with persistent pain. Anteflexion, abduction and external rotation, pain scores and the Oxford Shoulder Score all improved significantly (p<0.05) at all time points compared with preoperative. Quality of life improved significantly from 3 months onwards. These secondary outcomes improved further until 1 year postoperatively., Conclusion: Direct active rehabilitation after reverse total shoulder arthroplasty seems to be safe and effective. Potentially, this approach will lead to less dependent patients and faster recovery. Larger studies, preferably including a control group, should corroborate our results., Trial Registration Number: NL7656., Competing Interests: Competing interests: The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: DvK and RJH have a consultancy contract with Exactech Company. This study was not sponsored by Exactech. All other authors declare that they have no competing interests., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: A matched comparison of external beam radiotherapy (EBRT) versus brachytherapy recently demonstrated that EBRT appears at least as effective for palliating dysphagia in patients with incurable esophageal cancer. The aim of this analysis was to compare patient-reported outcomes (PROs) after EBRT versus brachytherapy., Materials and Methods: In a multicenter prospective cohort study, patients with incurable esophageal cancer requiring palliation of dysphagia were included to undergo EBRT (20 Gy in 5 fractions). This EBRT cohort was compared to the single-dose 12 Gy brachytherapy cohort of the previously reported SIREC-trial. Propensity score matching was applied to adjust for baseline imbalances. The primary endpoint of dysphagia improvement was reported previously. PROs were secondary outcomes and assessed at baseline and 3 months after treatment using EORTC QLQ-C30 and QLQ-OES18 questionnaires., Results: A total of 115 enrolled EBRT patients and 93 brachytherapy patients were eligible. After matching, 69 well-balanced pairs remained. At follow-up, significant deteriorations in functioning (i.e. physical, role, social), pain, appetite loss, and trouble with taste were observed after brachytherapy. In the EBRT group, such deterioration was observed only for role functioning, while significant improvements in trouble with eating and pain were found. Between-group comparison showed mostly comparable PRO changes, but significantly favored EBRT with regard to nausea, vomiting, pain, and appetite loss., Conclusion: Short course EBRT results in similar or better PROs at 3 months after treatment compared to single-dose brachytherapy for the palliation of malignant dysphagia. These findings further support its use and inclusion in clinical practice guidelines., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: The use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2-6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes., Methods and Analysis: In our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events., Ethics and Dissemination: The Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals., Trial Registration Number: Netherlands Trial Register (NL7656)., Competing Interests: Competing interests: van Kampen and Hillen have a consultancy contract with Exactech Company. This study was not sponsored by Exactech. Bogie has a consultancy contract with Zimmer Biomet. This study was not sponsored by Zimmer Biomet., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Short-course external beam radiotherapy (EBRT) and intraluminal brachytherapy are both accepted treatments for the palliation of dysphagia in patients with incurable esophageal cancer. We compared the effects of both treatments from two prospective studies., Methods: We performed a multicenter prospective cohort study of patients with metastasized or otherwise incurable esophageal cancer requiring palliation of dysphagia from September 2016 to March 2019. Patients were treated with EBRT in five fractions of 4 Gy. Data were compared with all patients treated with a single brachytherapy dose of 12 Gy in the SIREC (Stent or Intraluminal Radiotherapy for inoperable Esophageal Cancer) trial, both between the original cohorts and between 1:1 propensity score-matched cohorts. The primary end point was an improvement of dysphagia at 3 months without reintervention. The secondary end points included toxicity and time-to-effect., Results: A total of 115 patients treated with EBRT and 93 patients who underwent brachytherapy were eligible for analysis. In the original cohorts, dysphagia improved after EBRT in 79% of patients compared with 64% after brachytherapy (p = 0.058). Propensity score matching resulted in 69 patients in each cohort well-balanced at baseline. Improvement of dysphagia was observed in 83% after EBRT versus 64% after brachytherapy (p = 0.048). In responding patients, improvement of dysphagia at 2 weeks was observed in 67% after EBRT compared with 35% after brachytherapy, and the maximum effect was reached after 4 weeks in 55% and 33%, respectively. Severe toxicity occurred in 3% of patients after EBRT compared with 13% after brachytherapy., Conclusions: Short-course EBRT appears at least as effective as brachytherapy in the palliation of dysphagia in patients with esophageal cancer., (Copyright © 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Although intended to assess vulnerability factors associated with psychopathology, the 5-Dimensional Personality Test (5DPT) shows at least a superficial similarity to instruments that adhere to the lexical tradition in personality psychology. To investigate to which extent this similarity goes, this article compares the 5DPT with 2 lexically based measures, the NEO-Five Factor Inventory and the HEXACO-Personality Inventory-Revised. Moreover, as the NEO Openness to Experience construct demonstrates little relationship with maladaptive personality, whereas the 5DPT Absorption factor was hypothesized to underlie the emergence of positive schizotypic symptoms and related phenomena, the 5DPT was also correlated with the Schizotypic Syndrome Questionnaire (SSQ), the Creative Experiences Questionnaire, Thalbourne's Transliminality Scale, the Launay-Slade Hallucination Scale, and the OLIFE-Unusual Experiences scale. On examining the correlations between the various instruments, it was ascertained (a) that there is no need to extend the theory-informed 5DPT with a 6th dimension similar to the HEXACO factor Honesty-Humility, (b) that the 5DPT dimensions were found on average to share only a moderate amount of variance with the Five-factor model/Big Five factors, and (c) that the 5DPT Absorption scale turned out as anticipated to correlate with the positive symptom scales of the SSQ, as well as with the remaining criterion scales that measure similar constructs.

This study describes and tests two models of personality: the HEXACO model of personality, which is derived from the lexical tradition and which is rooted in "normal" psychology, and the 5DPT model of personality, which is derived from a theoretical approach and which is rooted in clinical psychology. The HEXACO and 5DPT models are compared in the prediction of antisocial and self-benefiting personality traits in a large-scale community sample study. Relative weight analyses show that HEXACO Honesty-Humility explains most of the variance in SRPIII Psychopathy, Egoism, and IPIP Pretentiousness, Immorality, and Machiavellianism. Additionally, Honesty-Humility is able to increment the amount of variance explained by the 5DPT scales in these antisocial and self-benefiting personality scales. Consequences for the 5DPT and for the choice of a dimensional axis-II personality model in the run-up of the DSM-V are discussed.

The principal aim of this paper is to investigate whether it is possible to create a personality taxonomy of clinical relevance out of Eysenck's original PEN model by repairing the various shortcomings that can be noted in Eysenck's personality theory, particularly in relation to P or Psychoticism. Addressing three approaches that have been followed to answer the question 'which personality factors are basic?', arguments are listed to show that particularly the theory-informed approach, originally defended by Eysenck, may lead to scientific progress. However, also noting the many deficiencies in the nomological network surrounding P, the peculiar situation arises that we adhere to Eysenck's theory-informed methodology, but criticize his theory. These arguments and criticisms led to the replacement of P by three orthogonal and theory-based factors, Insensitivity (S), Orderliness (G), and Absorption (A), that together with the dimensions E or Extraversion and N or Neuroticism, that were retained from Eysenck's PEN model, appear to give a comprehensive account of the main vulnerability factors in schizophrenia and affective disorders, as well as in other psychopathological conditions.

Fourteen men scoring high and 14 men scoring low on a positive schizotypy scale participated in a lateralized emotional Stroop task. Vocal reaction times for color naming of neutral, positive and negative emotional words were recorded. Across participants, the color naming of neutral and emotional words was slightly faster to right than to left visual field presentations. In men with high scores on positive schizotypy, the presentation of negative words to the left visual field (right hemisphere) resulted in significant affective interference with color naming, which was significantly larger than in men with low scores. Correlational analysis also showed that positive schizotypy was significantly associated with emotional interference in response to LVF negative words. The outcome is discussed in terms of right hemispheric engagement in negative emotions in high positive schizotypic men.

Background: SPEM dysfunction is a well-known phenomenon in schizophrenia. The principal aim of the present study was to examine whether SPEM dysfunction is already observable in subjects scoring high on a specific measure of schizotypy (SSQ General Schizotypy) that was selected because of its intimate relationship with schizophrenic prodromal unfolding., Methods: Applying ANOVAs, we determined the relationship of subjects' scores on SSQ General Schizotypy and eye movements elicited by targets of different speed. We also examined whether there exists an association between our schizotypy measure and pupil size., Results: We found more SPEM dysfunction in subjects scoring high on SSQ General Schizotypy than in subjects scoring average on that factor, irrespective of the speed of the target. No relationship was found between baseline pupil size and General Schizotypy., Conclusion: The present study provides additional evidence that SPEM dysfunction is associated with schizotypic features that precede the onset of schizophrenia and is already observable in general population subjects that show these features.

The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) appears to be a good choice for the assessment of personality pathology. However, due to its length, administration of the instrument is rather time-consuming, hindering standard inclusion of the DABB-BQ in a battery of assessment instruments at intake. We developed the 136-item DAPP-SF (Short Form), and investigated its psychometric characteristics in various samples, i.e., a community-based sample (n = 487), patients with mood-, anxiety-, and somatoform disorders (n = 1,329), and patients with personality disorders (n = 1,393). Results revealed high internal consistency for almost all dimensions. The factor structure appeared almost identical as compared to the factor structure of the original DAPP-BQ, and was shown to be invariant across the various patient and community samples. Indices for convergent, discriminant and criterion related validity were satisfactory. It is concluded that the good psychometric characteristics of the original DAPP-BQ were preserved in the shortened version of the instrument.

Aim: Validation of Van Kampen's Schizotypic Syndrome Questionnaire (SSQ) model of schizophrenic prodromal unfolding. The SSQ model comprises 12 negative, asocial and psychotic-like symptoms that are hypothesized to determine each other in terms of cause and effect., Method: Use was made of the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS)-dependent retrospective data assembled in the Mannheim Age-Beginning-Course Study sample of first-episode schizophrenic patients to measure the SSQ symptoms. Both the mean positions of the IRAOS-assessed symptoms on a continuum representing the proportion of total time of pre-psychotic disturbance and the outcome of a series of LISREL analyses conducted on the IRAOS-dependent data were addressed., Results: Both kinds of data supported the validity of the SSQ model; however, this was after introducing some (relatively minor or demonstrable ineffective) changes in the model as the 'translation' of the SSQ symptoms by means of the IRAOS was not always easy, or proved even impossible in the case of one symptom., Conclusions: The conclusion seems warranted that the present investigation supports the validity of the SSQ model as a model of pre-psychotic and prodromal unfolding in patients diagnosed as suffering from schizophrenia. From a theoretical perspective, arguments are presented to interpret the SSQ model as a model of the core or principal symptoms of schizophrenia, including their temporal unfolding., (© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Asia Pty Ltd.)

A short form of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), called the DAPP-SF, is presented, consisting of 136 of the original 290 items. It was established in a community sample that the factor structure of the DAPP-SF is highly congruent with the structure of the DAPP-BQ. The 18 DAPP-SF scales, which were found to be highly reliable, turned out to correlate substantially with the DAPP-BQ scales, even after applying a necessary correction, as the DAPP-SF was developed in the same sample used to investigate the Dutch DAPP-BQ. The higher-order convergent validity of the DAPP-SF was demonstrated by correlating the DAPP-SF scales and factors with Van Kampen's 5DPT. The same factor structure as found in the community sample of patients with personality disorder, also demonstrating that the agreement between the DAPP-SF and the DAPP-BQ is not dependent on the use of shared data. Finally, following Bagge and Trull [Bagge, C.L., Trull, T.J., 2003. DAPP-BQ: Factor structure and relations to personality disorder symptoms in a non-clinical sample. Journal of Personality Disorders 17, 19-32], specific predictions were tested concerning differences in means on the 18 scales between 10 diagnostic groups in the sample of patients with personality disorder. Results supported the validity of the DAPP-SF with respect to its lower-order structure. Finally, for practical purposes, preliminary norms are presented for females and males from the community in two different age groups.

This paper examines the psychometric properties (reliability and factor structure) and validity (relationship with various self-report measures and SPEM dysfunction) of the SSQ or Schizotypic Syndrome Questionnaire, a 108-item inventory for the measurement of 12 prodromal or schizotypic symptoms present in Van Kampen's model of schizophrenic prodromal unfolding. This paper also provides normative data for the SSQ. The SSQ demonstrates adequate reliability and breaks down into three correlated factors: negative schizotypy, asocial schizotypy and positive schizotypy. Results further attest the construct validity of the instrument. Because of the implications of the SSQ model for the definition of schizophrenia, the instrument's three-dimensional factor structure and the nature of one of the factors are discussed in more detail.

After modifying 53 items in a previous Dutch translation of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2002), the present DAPP-BQ scales (with or without Self-Harm included) were subjected to a principal components analysis with oblimin or varimax rotation in a general population sample of 478 subjects, retaining four factors. All four (higherorder) factors (Emotional Dysregulation, Dissocial, Inhibition, and Compulsivity) proved identical to the factors originally derived in Canada, with Tucker coefficients of factor similarity approaching unity. Particularly the (unexpected) finding that the present Dutch version of the DAPP-BQ also resulted in an Inhibition factor (and not, like the former Dutch version, in an Intimacy Problems factor) was considered positive. In addition, a principal components analysis with oblimin rotation was conducted on the 282 items contained in the 18 DAPP-BQ scales, investigating the lower-order structure of the DAPP-BQ; in this case, 18 factors were retained. Although the structure originally derived by Livesley and colleagues could not be recovered completely, the degree of similarity was of such a magnitude that the 18 DAPP-BQ scales were considered to give a dependable account of the "true" lower-order structure of disordered personality. Moreover, based on the finding that the 18 scales are sufficiently reliable (Cronbach's alpha) and correlate as predicted in a subsample of 284 subjects with the normal personality scales of Van Kampen's 5DPT (or, Five-Dimensional Personality Test), the DAPP-BQ appears to be a valuable instrument.

In this article a literature-based model (the Schizotypic Syndrome Questionnaire [SSQ] model) is presented that gives a description of the temporal unfolding of the schizophrenic prodrome. As a guiding principle for the selection of the symptoms in the model, the hypothesis was held that the main prodromal features determine each other in terms of cause and effect. Furthermore, the developmental pathways between the symptoms were not allowed to be in conflict with the usual observation that negative symptoms precede psychotic-like ones nor--at least in broad outline--with J.P. Docherty, D.P. van Kammen, S.G. Siris, and S.R. Marder's (1978) description of the various onset stages in the development of a schizophrenic psychosis. For the definitive version of the SSQ model, 12 symptoms were selected (e.g., affective flattening, suspicion, and delusional thinking). After specifying the paths to be estimated, the model was examined in two randomly drawn samples from a total community-based sample of 771 normal subjects and in the total sample itself, in each case resulting in adequate fit values. Moreover, all postulated pathways were found to be significantly different from zero. The use of a normal sample was based on the continuum hypothesis. Given the present-day discussions concerning the tenability of the schizophrenia concept, the model's implications with respect to that issue are particularly emphasized. Furthermore, the concept of the schizophrenia prodrome itself is critically discussed.

After discarding eight items in the Dutch translation of Livesley's DAPP-BQ that showed item-total correlations < 0.20 in a sample of 223 normal subjects. Cronbach's alpha coefficients were calculated for the remaining items in the 18 scales of this instrument. The 'Dutch' alpha coefficients proved to be satisfactory. Furthermore, the Dutch DAPP-BQ scales were factor analyzed, retaining four factors. Three of these factors proved to be identical (Emotional Dysregulation and Dissocial) or nearly identical (Compulsivity) to the Canadian factors. However, the original factor Inhibition was not the same as the remaining Dutch factor Intimacy Problems. In a sample of 115 students, the estimated scores for the Dutch Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) factors were correlated with the scales of Van Kampen's Four-Dimensional Personality Test. As expected, Emotional Dysregulation was found to correlate with Neuroticism, Dissocial with Insensitivity, and Compulsivity with Orderliness. The Intimacy Problems factor proved to be negatively correlated with Extraversion. The results obtained are embedded in the context of the evidence favoring a dimensional model of personality disorder. Furthermore, Livesley's proposal that separate diagnostic criteria for the existence of a personality disorder must be formulated to supplement the assessment by means of the DAPP-BQ is critically discussed.