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Despite the critical role of working memory (WM) in neuropsychiatric conditions, there remains a dearth of available WM-targeted interventions. Gamma and theta oscillations as measured with electroencephalography (EEG) or magnetoencephalography (MEG) reflect the neural underpinnings of WM. The WM processes that fluctuate in conjunction with WM demands are closely correlated with WM test performance, and their EEG signatures are abnormal in several clinical populations. Novel interventions such as transcranial magnetic stimulation (TMS) have been shown to modulate these oscillations and subsequently improve WM performance and clinical symptoms. Systematically identifying pathological WM-related gamma/theta oscillatory patterns with EEG/MEG and developing ways to target them with interventions such as TMS is an active area of clinical research. Results hold promise for enhancing the outcomes of our patients with WM deficits and for moving the field of clinical neuropsychology towards a mechanism-based approach.
Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Incl8-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.
Identify the prevalence of VRSA precursor organisms.
Prospective cohort with embedded case-control study.
Southeastern Michigan adults with chronic lower-extremity wounds.
Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Incl8-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).
Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Incl8-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.
Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.
Transcranial magnetic stimulation (TMS) is an effective and safe therapy for major depressive disorder (MDD). This study assessed quality of life (QOL) and functional status outcomes for depressed patients after an acute course of TMS.
Forty-two, U.S.-based, clinical TMS practice sites treated 307 outpatients with a primary diagnosis of MDD and persistent symptoms despite prior adequate antidepressant pharmacotherapy. Treatment parameters were based on individual clinical considerations and followed the labeled procedures for use of the approved TMS device. Patient self-reported QOL outcomes included change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the EuroQol 5-Dimensions (EQ-5D) ratings from baseline to end of the acute treatment phase.
Statistically significant improvement in functional status on a broad range of mental health and physical health domains was observed on the SF-36 following acute TMS treatment. Similarly, statistically significant improvement in patient-reported QOL was observed on all domains of the EQ-5D and on the General Health Perception and Health Index scores. Improvement on these measures was observed across the entire range of baseline depression symptom severity.
These data confirm that TMS is effective in the acute treatment of MDD in routine clinical practice settings. This symptom benefit is accompanied by statistically and clinically meaningful improvements in patient-reported QOL and functional status outcomes.
This chapter presents a discussion of the terminology of refractory depression, and three management strategies, namely optimization of the current drug, substitution of the current drug with a different drug, and combination of two or more drugs. It reviews and evaluates various combination approaches through a consideration of the following factors: mechanism of action, evidence of efficacy, specificity and predictors of response, safety, and clinical use. The chapter distinguishes three combination strategies on the basis of treatment objective: augmentation, acceleration, and stabilization. Augmentation refers to the simultaneous use of multiple agents to increase efficacy over what might be obtained with any one of the agents used. Some of the combination agents discussed in the chapter includes lithium, triiodothyronine (T3), buspirone, stimulants, neuroleptics, and 5-HT1A antagonists. Buspirone is an azapirone derivative which acts as an agonist at the 5-HT1A receptor.
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