Does this man with lower urinary tract symptoms have bladder outlet obstruction?: The Rational Clinical Examination: a systematic review.

IMPORTANCE: Early, accurate diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms may reduce the need for invasive testing (ie, catheter placement, urodynamics), and prompt early treatment to provide symptomatic relief and avoid complications. OBJECTIVES: To systematically review the evidence on (1) the diagnostic accuracy of office-based tests for bladder outlet obstruction in men with lower urinary tract symptoms; and (2) the accuracy of the bladder scan as a measure of urine volume because management decisions rely on measuring postvoid bladder residual volumes. DATA SOURCES AND STUDY SELECTION: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (1950-March 2014), along with reference lists from retrieved articles were searched to identify studies of diagnostic test accuracy among males with lower urinary tract symptoms due to bladder outlet obstruction. MEDLINE, EMBASE, CINAHL, and the Cochrane Library (1950-March 2014) were searched to identify studies of urine volumes measured with a bladder scanner vs those measured with bladder catheterization. Prospective studies were selected if they compared 1 or more office-based, noninvasive diagnostic test with the reference test or were invasive urodynamic studies, and if urine volumes were measured with a bladder scanner and bladder catheterization. DATA EXTRACTION AND SYNTHESIS: For the bladder outlet obstruction objective, 8628 unique citations were identified. Ten studies (1262 patients among 9 unique cohorts) met inclusion criteria. For the bladder scan objective, 2254 unique citations were identified. Twenty studies (n = 1397 patients) met inclusion criteria. MAIN OUTCOMES AND MEASURES: The first main outcome and measure was the diagnostic accuracy of individual symptoms and questionnaires compared with the reference standard (urodynamic studies) for the diagnosis of bladder outlet obstruction in males with lower urinary tract symptoms. The second was the correlation between urine volumes measured with a bladder scanner and those measured with bladder catheterization. RESULTS: Among males with lower urinary tract symptoms, the likelihood ratios (LRs) of individual symptoms and questionnaires for diagnosing bladder outlet obstruction from the highest quality studies had 95% CIs that included 1.0, suggesting they are not significantly associated with one another. An International Prostate Symptom Score cutoff of 20 or greater increased the likelihood of bladder outlet obstruction (positive LR, 1.5; 95% CI, 1.1-2.0), whereas scores of less than 20 had an LR that included 1.0 in the 95% CI (negative LR, 0.82; 95% CI, 0.67-1.00). We found no data on the accuracy of physical examination findings to predict bladder outlet obstruction. Urine volumes measured by a bladder scanner correlated highly with urine volumes measured by bladder catheterization (summary correlation coefficient, 0.93; 95% CI, 0.91-0.95). CONCLUSIONS AND RELEVANCE: In patients with lower urinary tract symptoms, the symptoms alone are not enough to adequately diagnose bladder outlet obstruction. A bladder scan for urine volume should be performed to assess patients with suspected large postvoid residual volumes.

Pharmacotherapy for personality disorder-prescribing practice at a high secure hospital: a preliminary report.

The aim of this study was to examine the prescription of psychotropic medication for patients with a primary diagnosis of personality disorder (PD) detained at Rampton High Secure Hospital, compared with that for patients with a primary diagnosis of mental illness. The name and the dose of psychotropic medication prescribed for each patient in the sample, on 2 July 2010, were examined. Although nearly all patients with a primary diagnosis of mental illness were prescribed psychotropic medication (98%), the percentage within the Personality Disorder (73%) and the Dangerous and Severe Personality Disorder services (62%) was also high, with the most commonly prescribed drug being an antipsychotic in all groups. The dose of antipsychotic and mood-stabilizing medication was lower for patients with a primary diagnosis of PD, and clozapine was the antipsychotic of choice for a significant proportion of these patients. Medication may have a key role to play in the management of some groups of patients with PD.

Retroperitoneal liposarcoma in an adult patient with Down syndrome.

Retroperitoneal liposarcoma is a rare solid tumour of mesenchymal origin with an incidence of 2.5 per million population. We report what is, to the best of our knowledge, the first case in the English literature of retroperitoneal liposarcoma in an adult patient with Down syndrome. The tumour was surgically resected with no use of adjuvant chemotherapy or radiation. No recurrence was found at follow-up 2 months postoperatively. Clinicians should consider retroperitoneal liposarcoma in the differential diagnosis of abdominal distention in adult patients with Down syndrome.

Involving patients in research: the challenge of patient-centredness.

BACKGROUND: The concept of patient-centredness is increasingly being incorporated into modern healthcare practice, yet little attention has been given to the development of patient-centred principles in research. AIMS: This study aimed to establish convergent validity for a definition of patient-centredness using abstracts from schizophrenia research and to explore the experiences of psychiatrists and service users taking part in research that was designed to be patient-centred. METHODS: Mixed methods were used in this community study. RESULTS: Thirteen service users and three psychiatrists took part. Service users rated eight of 60 research abstracts as patient-centred, even though 30 of these had been previously rated as such by psychiatrists. There was some accord between psychiatrist and service user ratings as seven out of eight abstracts were identified by both groups as patient-centred. Process aspects of research were valued by service users, for example, being respected as collaborators. Both groups reported benefits to participation in patient-centred research, such as feeling valued and breaking down barriers between doctor and patient. CONCLUSIONS: While there is some agreement between professionals and service users as to what constitutes patient-centred research, other process-related factors are important. Patient-centred research is valued by both service users and doctors and should be incorporated into future studies.

International schizophrenia research and the concept of patient-centredness: an analysis over two decades.

BACKGROUND: Patient-centred medicine improves psychological and physiological functioning in chronic illnesses. AIMS: To determine to what extent the patient-centred ethos (as exemplified by research addressing subjective experiences) was incorporated into work presented at major international schizophrenia research forums between 1988 and 2004. METHOD: Whole population-based, retrospective cohort study using abstracts from the International Congress on Schizophrenia Research and the Biennial Winter Workshop on Schizophrenia (n = 9,284). Comparative analysis using abstracts from the International Society for the Psychological Treatment of Schizophrenia (n = 992). Patient-centredness was assessed by determining the number of abstracts that primarily addressed participants' subjective experiences. RESULTS: Research was presented from 50 countries globally. European and North American countries produced 8,573 (92%) of the total. Biological research was the main theme of 6,960 (75%) of the abstracts, with psychosocial research constituting less than 5%. One hundred and eighty three (2%) abstracts from the two main conferences addressed subjective experiences, as did 333 (34%) from the comparative analysis. CONCLUSIONS: Between 1988 and 2004 research emanating from North American and European countries, together with biologically orientated research, were the most prevalent perspectives on schizophrenia. It appears that research into the subjective experiences of participants has not been as prevalent as more objective accounts of the disorder, suggesting that this research effort has not been patient-centred.

Learning of dynamic display AAC technologies by typically developing 3-year-olds: effect of different layouts and menu approaches.

The present study investigated the learning demands of dynamic display augmentative and alternative communication (AAC) technologies that differed in system layout and menu page approaches for 3-year-old children. Ten typically developing children were randomly assigned to each of 3 technology approaches and were asked to located vocabulary items within a play context. Results indicated that the children had difficulty with all of the technologies on initial exposure. After the 1st learning session, children performed significantly better with AAC technologies in a contextual scene format than in a grid format. Some limited generalization to new vocabulary was evident. AAC technologies for young children need to be redesigned to better reflect the developmental models of children. Results are discussed with implications for practice and suggestions for future research.

Does treatment really make psychopaths worse? A review of the evidence.

We aimed to evaluate critically the evidence behind the perceived inverse association between the degree of psychopathy as reflected by a high score on the Hare Psychopathy Checklist-Revised (PCL-R) and treatment response. A literature search with the key identifiers of PCL-R (or its derivatives) and treatment response produced 24 studies that were then systematically evaluated. This showed that only three studies were of an appropriate research design to answer the question and of these, none met our standard for an acceptable study. We conclude therefore that the commonly held belief of an inverse relationship between high-scores on the PCL-R and treatment response has not been established.