The long-term course of cognition in bipolar disorder: a systematic review and meta-analysis of patient-control differences in test-score changes

Neuropsychological impairment represents a key aspect of bipolar disorder (BD) that is evident even in early-course patients and is a strong predictor of functional outcomes among those affected. Previous meta-analyses of longitudinal studies suggest that BD-related cognitive deficits may not progress along the course of the disorder. However, short test-retest periods were used in most primary studies and comparisons with healthy controls were limited. The aim of this review was to synthesize the findings of research reports comparing long-term neurocognitive trajectories between BD patients and healthy individuals. PubMed, PsycINFO, and Scopus databases were searched from inception through July 2021. Publications were considered for inclusion if they reported cognitive test scores of BD patients and healthy controls at two different time points, with a minimum test-retest interval of 5 years. Fifteen studies compared the long-term course of cognition in BD patients with that of healthy controls. Ten of these were included in the quantitative analysis and involved 540 BD patients and 644 healthy individuals (mean follow-up period: 8.9 years). Patient-control effect sizes (standardized mean differences) were calculated for test-score changes in 24 neuropsychological variables and combined by means of meta-analytic procedures. No significant differences were found between patients and controls regarding long-term cognitive outcomes. These findings are consistent with previous shorter-term longitudinal meta-analyses and do not provide evidence for progressive cognitive deterioration in most bipolar individuals. Future studies should address the longitudinal course of cognition in different subgroups of BD patients and its prognostic and therapeutic value.

Shared Decision-Making towards a Higher Quality of Care: Is this the Norm?

Patient-doctor relationship has traditionally been paternalistic, in which the doctor decided on behalf of the patient. It focused mainly between the patient who called for help and the doctor whose decisions had to be silently observed and followed by the patient. In this paternalistic model, the physician used his skills to choose the necessary interventions and treatments that were likely to restore the health of the patient. All the information given to the patient was selected to encourage them to consent to the doctor’s decisions. This definition of the asymmetric or unbalanced interaction between physicians and patients has begun to be questioned over the last 20 years. There has been a shift from this direction to one where the patient is more informed, empowered, and independent - a move from a “paternalistic” to a more “complementary” relationship. Critics suggested a more active, autonomous patient-centered role which supports greater patient control, reduced doctors’ dominance, and a more mutual participation. This approach has been described as one where the doctor attempts to enter the patient’s world to see the disease with the eyes of the patient and is becoming the predominant model in clinical practice today.

Prospective switch study comparing two irrigation systems for transanal irrigation in children

Background and study aims: Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®. Patients and methods: This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used. Results: Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785). Conclusions: In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.

Hubungan motivasi kontrol pasien dengan kepatuhan kontrol orthodonti cekat pada masa pandemi COVID-19

Background: The motivation to control patients for fixed orthodontic treatment usually comes from themselves or from outside that affects the expected goals. During the Covid-19 pandemic, dental services, especially orthodontic treatment, were disrupted. This treatments requires a long and continuous time and process,in order to obtain maximum results, patient compliance is required to control. Research objectives: To know the correlation between patients motivation control and compliance of fixed orthodontic appliance control in pandemic of Covid-19 times at clinics in Yogyakarta. Research method: This research method is analytic survey with cross sectional approach. The population of study was fixed orthodontics users who visited the dental clinic at January-November 2020 and used fixed orthodontics for 12 months. Sampling using accidental sampling technique data collection using primary data taken from the results of questionnaires and secondary data taken and report of patient visits data analysis using The Kendalls Tau test. Research results: The gender of female had strong control motivation as much as16 people (53.3%), higher than 7 people (23.3%), while the adherence of female controls had adherence criteria as many as 18 people (60.0%) were higher thanthat of men. Male as many many as 8 people (26.7%). The result showed a significant relationship between patient control motivation and adherence to fixedorthodontic control during the Covid-19 pandemic at aclinic in Yogyakarta, with a value of p=0.033<0.05, while the correlation coefficient value was 0.293. Conclusion: Patient control motivation has a fairly close relationship with adherence to fixed orthodontic controls during the Covid-19 pandemic, becausethe higher the level of patient control motivation, the higher the patients compliance to perform fixed orthodontic control.

93 Acute magnetic resonance imaging for mild traumatic brain injury

Aims/Objectives/BackgroundMild traumatic brain injury (mTBI) accounts for one million emergency department attendances in the UK every year. Whilst 30–50% of patients suffer from persistent symptoms, unselected follow up would overwhelm the health care system. Magnetic resonance imaging (MRI), may help to stratify patients for clinical follow up and interventional trials. We therefore aimed to identify:Neuroanatomical features of concussion on MRI andthe optimal timing for magnetic resonance imaging (<72h or 2–3 weeks after injury).This is the largest study to date using serial scanning acutely in patients with mTBI.Methods/DesignData originated from two prospective cohorts: the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study (2014–2017) and a local cohort (2012–2013). Eligible patients presented to hospital within 24h of a mTBI (Glasgow Coma Score 13–15), satisfied local criteria for computed tomography scanning and received two MRIs: one within 72h (MR1) and one 2–3 weeks after injury (MR2). In addition, 104 controls were enrolled. Volumes and diffusion parameters for brain regions of interest were extracted via automated pipelines. Symptoms were measured using the Rivermead Post-Concussion Questionnaire acutely and the extended Glasgow Outcome Score at three months.Results/ConclusionsThe study included 81 patients (73 from CENTER-TBI, 8 local) with a median age of 44 years (range 14–85) and 57 (70%) men. Within patients, cerebral white matter volume decreased (MR1/MR2 0.98, p=0.001) and ventricular volume increased (MR1/MR2 1.06, p<0.001). Compared to controls, white matter volume was normal on MR1 (patient/control 1.00, p=0.277) but reduced on MR2 (patient/control 0.97, p<0.001). Diffusion changes followed one of three trajectories: progressive injury, minimal change, or pseudonormalisation. Concussion symptoms worsened, improved and were variable in the three groups respectively (delta [IQR] + 5.00 [+2.00-+5.00], -4.5 [-9.25-+1.75], 0.00 [-6.25 to +9.00], p=0.018). MR1 predicted three-month outcome better than MR2 (AUC [95% CI]: 0.93 [0.83–1.00] vs 0.72 [0.51–0.92]).

HARDI-ZOOMit protocol improves specificity to microstructural changes in presymptomatic myelopathy

Diffusion magnetic resonance imaging (dMRI) proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy. Aim of the study is to present a fast multi-shell HARDI-ZOOMit dMRI protocol and validate its usability to detect microstructural myelopathy in NMDCCC patients. In 7 young healthy volunteers, 13 age-comparable healthy controls, 18 patients with mild NMDCCC and 15 patients with severe NMDCCC, the protocol provided higher signal-to-noise ratio, enhanced visualization of white/gray matter structures in microstructural maps, improved dMRI metric reproducibility, preserved sensitivity (SE = 87.88%) and increased specificity (SP = 92.31%) of control-patient group differences when compared to DTI-RESOLVE protocol (SE = 87.88%, SP = 76.92%). Of the 56 tested microstructural parameters, HARDI-ZOOMit yielded significant patient-control differences in 19 parameters, whereas in DTI-RESOLVE data, differences were observed in 10 parameters, with mostly lower robustness. Novel marker the white-gray matter diffusivity gradient demonstrated the highest separation. HARDI-ZOOMit protocol detected larger number of crossing fibers (5–15% of voxels) with physiologically plausible orientations than DTI-RESOLVE protocol (0–8% of voxels). Crossings were detected in areas of dorsal horns and anterior white commissure. HARDI-ZOOMit protocol proved to be a sensitive and practical tool for clinical quantitative spinal cord imaging.