The STIRR model of best practices for blood-borne diseases among clients with serious mental illness.

Objective: Persons with severe mental illness have a markedly elevated risk of several blood-borne infections, including HIV, hepatitis B, and hepatitis C. Prevention, early detection, and treatment of these disorders are crucial interventions for high-risk populations. However, because of a number of barriers, most clients with severe mental illness do not receive these basic best-practice services.

A novel human cancer vaccine elicits cellular responses to the tumor-associated antigen, human chorionic gonadotropin beta.

Purpose: The oncofetal antigen, human chorionic gonadotropin beta subunit (hCGbeta), is expressed by a number of carcinomas and is a prognostic indicator in renal, colorectal, bladder, and pancreatic cancers. We describe the development of a novel antibody-based dendritic cell (DC)-targeted cancer vaccine capable of eliciting cellular immune responses directed against hCGbeta.

Experimental Design: The tumor-associated antigen hCGbeta was coupled genetically to a human anti-DC antibody (B11).

The burden of prevention: downstream consequences of Pap smear testing in the elderly.

Context: Although cervical cancer is an unusual cause of death among women 65 and older, most elderly women in the US report continuing to undergo periodic Pap smear screening.

Objective: To describe the incidence of Pap smears and downstream testing among elderly women.

Setting: Claims-based analysis of female Medicare enrollees age 65 and older.

The role of docetaxel in nonplatinum-based combination chemotherapy for non-small-cell lung cancer.

A number of newer chemotherapeutic agents including docetaxel, gemcitabine, irinotecan, and vinorelbine have demonstrated substantial activity in the treatment of non-small-cell lung cancer (NSCLC). Their palliative role as single agents and in combination with platinum has been well defined in NSCLC. More recently, combining these agents without platinum has been the primary objective of numerous worldwide clinical trials.

Technology evaluation: ING-1, XOMA.

XOMA is developing ING-1, a human engineered immunoglobulin G1 antibody, as a potential treatment for carcinoma and solid tumors. In November 2000, ING-1 entered phase I trials in the US and by February 2002, phase I/II trials had been initiated.

Responding to blood-borne infections among persons with severe mental illness.

The Five-Site Health and Risk Study estimated prevalence rates of blood-borne infections, including the human immunodeficiency virus (HIV), hepatitis B, and hepatitis C, and addressed risk factors and correlates of infection among persons with severe mental illness. In this final article of the special section in this issue of Psychiatric Services, the authors review public health recommendations and best practices and discuss the implications of these results for community mental health care of clients with severe mental illness. Standard public health recommendations could be modified for use by community mental health providers.

Syndecan-4 modulates basic fibroblast growth factor 2 signaling in vivo.

Syndecan-4 is one of the principal heparan sulfate-carrying proteins on the cell surface. Unlike other members of syndecan family, syndecan-4 mediates phosphatidylinositol 4,5-bisphosphate 2 (PIP(2))-dependent PKC-alpha activation, and overexpression of syndecan-4 in vitro results in enhanced FGF2 signaling. The present study was designed to test the functional effect of increased syndecan-4 expression in endothelial cells in transgenic mice.

Lung cancer prevention: the guidelines.

Lung carcinogenesis is a chronic and multi-step process resulting in malignant lung tumors. This progression from normal to neoplastic pulmonary cells or tissues could be arrested or reversed through pharmacologic treatments, which are known as cancer chemoprevention. These therapeutic interventions should reduce or avoid the clinical consequences of lung cancer by treating early neoplastic lesions before the development of clinically evident signs or symptoms of malignancy.

Primary care pediatricians' roles and perceived responsibilities in the identification and management of maternal depression.

Objective: To describe the attitudes and approaches of primary care pediatricians in the identification and management of postpartum and other maternal depression.

Methods: A national survey of randomly selected primary care pediatricians reported their management of the last recalled case of postpartum or other maternal depression, barriers to care, their attitudes about recognition and management, confidence in skills, and their willingness to implement new strategies to improve care.

Results: Of 888 eligible primary care pediatricians, 508 (57%) completed surveys.

Research on posttraumatic stress disorder: epidemiology, pathophysiology, and assessment.

Posttraumatic stress disorder (PTSD) is a highly prevalent disorder in both clinical and community populations. This article reviews current knowledge about PTSD in order to assist clinicians in the diagnosis and treatment of reactions to traumatic life events. First, research findings are presented, followed by guidelines for the assessment of trauma and PTSD.

Evidence for longitudinal ambulatory care rotations: a review of the literature.

Purpose: Block ambulatory rotations and longitudinal ambulatory care experiences are now common in U.S. medical schools, but little is known about their efficacy.

Glycogen synthase deficiency (glycogen storage disease type 0) presenting with hyperglycemia and glucosuria: report of three new mutations.

Although glycogen storage disease type 0 (GSD0) is included in the differential diagnosis of ketotic hypoglycemia, it usually is not considered in the evaluation of glucosuria or hyperglycemia. We describe two children with GSD0, confirmed by mutation analysis, who had glucosuria and hyperglycemia. Because of the variable presentation of this disorder and previous dependence on liver biopsy to confirm diagnosis, it is likely that GSD0 is underdiagnosed.

Reduction mammaplasty: defining medical necessity.

The authors evaluated existing and new criteria for defining the medical necessity for breast reduction surgery. Two cohorts of women (those requesting breast reduction surgery [N = 266] and a group of controls [N = 184]) completed a questionnaire including breast-specific symptom severity, the Short Form 36, the EuroQol, the McGill Pain Questionnaire, and the Multidimensional Body Self Relations Questionnaire. To evaluate prediction validity, the most widely accepted decision criteria and a new definition of medical necessity were applied to the data set to determine whether women meeting the definition had more favorable outcomes than those who did not as measured by validated self-report instruments.

Epidural anesthesia and analgesia: effects on recovery from cardiac surgery.

Objective: To measure predefined clinical effects resulting from the use of epidural anesthesia and analgesia during and after cardiac surgery.

Design: Prospective, randomized, nonblinded clinical trial.

Setting: Single academic medical center.

Secondarily generalized seizures in mesial temporal epilepsy: clinical characteristics, lateralizing signs, and association with sleep-wake cycle.

Purpose: Secondarily generalized seizures (SGSs) are often considered to be stereotyped, presumably sharing a common electrical pathway. We examined whether SGSs are uniform in a homogeneous group of patients with mesial temporal epilepsy, and whether certain clinical signs associated with generalization are lateralizing with regard to seizure origin.

Methods: A comprehensive, standardized video/EEG analysis was performed of the clinical characteristics of 29 patients (69 SGSs) with mesial temporal seizure onset.

The health burden of breast hypertrophy.

Women seeking consultation for the surgical relief of symptoms associated with breast hypertrophy have been the focus of many studies. In contrast, little is known about those women with breast hypertrophy who do not seek symptomatic relief. The purpose of this study was to describe the health burden of breast hypertrophy by using a set of validated questionnaires and to compare women with breast hypertrophy who seek surgical treatment with those who do not.

Asymptomatic QTc prolongation associated with quetiapine fumarate overdose in a patient being treated with risperidone.

We report a patient who ingested a 2000-mg overdose of quetiapine fumarate (Seroquel). Her maintenance medications also included risperidone, venlafaxine, topiramate, and clonazepam. On presentation, she was drowsy, but had no other significant CNS signs and no cardiac symptoms or abnormal physical signs.

Intractable seizures of frontal lobe origin: clinical characteristics, localizing signs, and results of surgery.

Purpose: We analyzed the clinical characteristics of seizures of frontal lobe (FL) origin with particular emphasis on establishing different categories and determining if these categories had any localizing or lateralizing value. In addition, results of surgery are reported.

Methods: Seizure characteristics were established by historical review and electroencephalographic/videotape analysis of 449 seizures in 26 adult patients with refractory seizures of FL origin.

Effectiveness of combining atypical antipsychotics and psychosocial rehabilitation in a community mental health center setting.

This article presents a consecutive case series of 70 patients treated with olanzapine, case management, and psychosocial rehabilitation in a community mental health setting. This group demonstrated highly significant improvement on all analyzed measures of symptoms and psychosocial function at 6-month follow-up. These findings suggest that results of efficacy studies of olanzapine will generalize to the community mental health setting.

Prolonged intestinal exposure to amniotic fluid does not result in peel formation in gastroschisis.

The etiology of bowel wall changes in infants with gastroschisis remains unknown. Currently, debate focuses on the relative roles of amniotic fluid exposure versus that of intestinal ischemia. The authors report five cases of prenatally diagnosed gastroschisis in which the bowel was exposed to amniotic fluid for up to 21.

The effects of BCG immunization and human immunodeficiency virus infection on dual skin test reactions to purified protein derivative and Mycobacterium avium sensitin among adults in Zambia.

Setting: University hospital in Lusaka, Zambia.

Objective: To determine the effects of childhood bacille Calmette-Guerin (BCG) immunization and human immunodeficiency virus (HIV) infection on dual skin test reactions to purified protein derivative (PPD) and Mycobacterium avium sensitin (MAS) in a developing country.

Design: Descriptive cross-sectional study.

Elaboration of an alternative, segmental, cartilage-sparing tip graft technique: experience in 405 cases.

Despite the value of tip grafting in many rhinoplasty patients, adequate donor cartilage may be unavailable in secondary and even primary patients whose donor sites have been harvested previously or whose septal cartilage is calcified. Furthermore, by enlarging the lobule, tip grafts can create undesirable postoperative disproportions in some patients. These two observations have stimulated the elaboration of a tip graft method (which evolved from the Sheen technique) that uses small amounts of autogenous donor material to augment only those lobular segments that require increased contour or support, without necessarily increasing overall lobular volume.