ORCID Profile
0000-0002-4773-8518
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Publisher: Royal College of Psychiatrists
Date: 2016
DOI: 10.1192/BJP.BP.114.162123
Abstract: Few randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder. To examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline. This was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668). There was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group ( F = 3.071, d.f. = 2, P = 0.049). Improvement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.SCHRES.2018.03.025
Abstract: Many studies having shown significant improvements in non-social and social cognitive performance in smoking FEP patients compared to non-smoking FEP patients. The findings are controversial. This study analyzed the effects of tobacco use on non-social and social cognitive function in a large group of FEP patients and a matched healthy control group. A s le of 335 patients with FEP and 253 healthy controls was ided into four subgroups: control tobacco users (CTU), control non-tobacco users (CNTU), patient tobacco users (PTU) and patient non-tobacco users (PNTU). Demographic variables, tobacco use variables (presence or absence, frequency and duration of tobacco use), neurocognitive (non-social) performance and social cognition were assessed. Comparison of 4 subgroups in non-social cognitive function revealed significant differences after controlling for covariables in executive functions (F=13.45 p≤0.001) and working memory domains (F=4.30 p=0.005). CTU and CNTU subgroups scored higher in all the domains compared to the PTU and the PNTU subgroups respectively. Social cognitive function was also significantly different within the four subgroups, with control subgroups showing better social cognition than patient subgroups. Significant differences in the executive functions domain were observed when comparing PTU and CTU groups (F=19.60 p≤0.001). No significant differences were revealed in the comparison between the patient groups. This large study suggests that tobacco use in FEP patients is not related to better non-social or social cognitive performance.
Publisher: Wiley
Date: 2005
DOI: 10.1002/CCD.20534
Abstract: To perform a randomized, ultrasound controlled trial to define the procedural and clinical advantages and limitations of 6 French (Fr) compared with 7 Fr transfemoral coronary intervention in the stenting era. The use of 7 Fr guiding catheters may facilitate Percutaneous Coronary Intervention (PCI), but may be associated with increased vascular complications when compared with 6 Fr catheters. Patients undergoing PCI considered suitable for either a 6 or 7 Fr sheath and guiding catheter system were included. All vascular sheaths were removed with assisted manual compression. Femoral vascular ultrasounds were performed prior to hospital discharge and interpreted by a vascular surgeon blinded to treatment assignment. The primary endpoint was a composite of significant vascular complications including major haematoma, retroperitoneal haematoma, pseudoaneurysm, arterio-venous fistula, or femoral venous or arterial thrombosis. During the study, 414 patients (mean age 61+/-11 years, 27% females) were randomly assigned to 6 Fr or 7 Fr sheath groups. The incidence of major vascular complications was 5.7% in the 6 Fr group and 3.9% in the 7 Fr group (P=0.383). There was no significant difference in procedural or angiographic success between the groups. The use of contrast volume was higher in the 7 Fr group (157+/-58 ml vs. 144+/-58 ml P=0.029). There was a trend toward better operator satisfaction with the 7 Fr guide (P=0.08). This prospective, randomized trial indicates no reduction in major peripheral vascular complications with the use of smaller guiding catheters in PCI. There was less contrast used in the 6 Fr group, which may benefit some patient subsets, however operators tended to prefer the larger 7 Fr system. The target coronary anatomy and need for complex device intervention should mandate the choice of guiding catheter size, not a perceived impact on vascular complications.
Publisher: Wiley
Date: 30-12-2015
DOI: 10.1111/ACPS.12535
Abstract: Cognitive reserve (CR) is a concept that was postulated as a protective factor for some clinical symptoms after the observation that there is not a direct relationship between the degree of brain damage and its clinical manifestation. This study aimed to explore the association between CR and the main outcomes in bipolar disorder (BD): cognitive functions, psychosocial functioning and perceived quality of life. A s le of 224 euthymic bipolar patients was assessed with a neuropsychological battery, the Functioning Assessment Short Test and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CR was calculated through three proxies: estimated premorbid Intelligent Quotient, educational level and occupational attainment. Relationships between CR and cognitive functions, psychosocial functioning and quality of life were assessed by multiple linear regression models. Higher CR was associated with better cognitive functioning (P < 0.001 in processing speed, working memory, verbal and visual memory, and executive function P = 0.026 in attention) and better psychosocial functioning (P = 0.008). For quality of life, CR was positively associated with the physical component of the SF-36 (P = 0.016) but negatively associated with the mental component (P = 0.004). The results suggest that CR may play an important role in the course and prognosis of bipolar patients and it should be considered in both clinical and research settings related to BD.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.JAD.2014.02.034
Abstract: Most studies on the factors involved in the functional outcome of patients with bipolar disorder have identified subsyndromal depressive symptoms and cognitive impairment as key players. However, most studies are cross-sectional and very few have analyzed the interaction between cognition and subclinical depression. The present study aimed to identify the role of cognition, and particularly verbal memory, and subthreshold depressive symptoms in the functional outcome of patients with bipolar I and II disorder at one year follow-up. A confirmatory analysis was performed using the path analysis. A total of 111 euthymic patients were included to test the role of verbal memory as a mediator in the relationship of subthreshold depressive symptoms and functional outcome at one year follow-up. Measures of verbal memory, subthreshold depressive symptoms and functioning (at baseline, at 6 months and at one year follow-up) were gathered through the use of a neuropsychological assessment and validated clinical scales. The hypothesized mediation model displayed a good fit to data (Chi=0.393, df=2, p=0.625 RMSEA<0.001 with CI: 0.001-0.125 and CFI=1.00). Functional outcome at one year follow-up was predicted by the functional outcome at baseline, which in turn, was related to subthreshold depressive symptoms at baseline and to the verbal composite memory scores as a mediator variable. The results of this study prospectively confirm previous findings on the disabling role of subthreshold depressive symptoms and verbal memory impairment on psychosocial functioning. However, these results come from a s le with moderate to severe functional impairment hence, as a limitation, this may hinder the generalization of these results.
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.HLC.2007.07.011
Abstract: Previous studies in the pre-stent era have evaluated the postprocedural use of unfractionated heparin (UFH) on clinically defined vascular complications and ischaemic cardiac complications. We prospectively evaluated the benefits and risks of this practice, using vascular ultrasound determined endpoints in the current stent era. Patients undergoing percutaneous coronary intervention (PCI) and enrolled in two of our previous routine and prospective vascular ultrasound studies were included in the analysis. Generally the decision to use UFH after sheath removal was at the discretion of the operator, however a subset of patients was randomised to receive UFH or not. Femoral vascular ultrasound was performed prior to hospital discharge and interpreted by an experienced vascular ultrasonographer blinded to whether UFH was used or not. The primary endpoint was a composite of significant vascular ultrasound determined complications including major haematoma, pseudoaneurysm, arterio-venous fistula, femoral venous or arterial thrombosis and retroperitoneal haemorrhage. Secondary endpoints included in hospital ischaemic events, length of stay and outcome at 30 days. A total of 530 patients (43% receiving UFH) were included in the analysis. The incidence of the primary endpoint for the entire population was 4.0% in both the UFH and no UFH groups (p=1.00). In the 226 (43%), randomised patient subset, the primary endpoint occurred in 5.2% in the UFH group and 4.5% in the no UFH group (p=0.80). Time to ambulation and discharge was similar in both groups. At 30 days, the incidence of major adverse cardiac events (4.7% for entire cohort) was similar in all groups whether randomised or not. When vascular ultrasound is used to determine major vascular complications the use of UFH after PCI in the stent era was not associated with increased major vascular complications. We also failed to provide evidence of a meaningful clinical benefit with the routine use of postprocedural heparin in this selected patient cohort.
Publisher: Elsevier BV
Date: 02-2002
DOI: 10.1016/S0039-6109(03)00150-6
Abstract: Vascular injury poses a small but significant challenge in Australian trauma care. Opportunities such as better practice guidelines and minimum standards will allow surgeons to improve delivery of quality care to the next generation of vascular trauma victims. Training in the management of vascular trauma surgery with integration of vascular and general surgery in trauma care should optimize outcomes. The authors' vision is that all vascular and general surgery trainees would eventually undertake the Definitive Surgical Trauma Care Course and improve vascular trauma outcomes and reduce mortality.
Publisher: Public Library of Science (PLoS)
Date: 11-08-2016
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/ANS.15823
Publisher: American Psychiatric Association Publishing
Date: 08-2013
DOI: 10.1176/APPI.AJP.2012.12070971
Abstract: OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a s le of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a s le of euthymic bipolar patients as compared with treatment as usual.
Publisher: Cambridge University Press (CUP)
Date: 22-10-2019
DOI: 10.1017/S0033291719002794
Abstract: Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. The s le of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively). Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
Publisher: Wiley
Date: 2004
DOI: 10.1002/CCD.20161
Abstract: We assessed patient tolerance and resource utilization of using the AngioSeal closure device versus assisted manual compression using the Femostop device after percutaneous coronary intervention (PCI). Patients undergoing PCI with clean arterial access and no procedural hematoma were randomized to receive the AngioSeal or Femostop device to achieve femoral arterial hemostasis. Times from procedure end to removal from angiography table, hemostasis, ambulation, and hospital discharge were recorded. Bedside nursing/medical officer care time, vascular complications, and disposable use were also documented. Patient comfort was assessed using Present Pain Intensity and Visual Analogue scales at baseline, 4 hr, 8 hr, and the morning after the procedure. One hundred twenty-two patients were enrolled (62 AngioSeal, 60 Femostop). Patients in the AngioSeal group took longer to be removed from the angiography table (11 +/- 4 vs. 9 +/- 3 min P = 0.002) compared with the Femostop group. Time to hemostasis (0.4 +/- 1.1 vs. 6.4 +/- 1.7 hr P < 0.001) and ambulation (17 +/- 8 vs. 22 +/- 13 hr P = 0.004) were less in the AngioSeal group, although time to discharge was not different. Nursing and medical officer time was no different. Disposables including device cost were higher in the AngioSeal group (209 dollars +/- 13 vs. 53 dollars +/- 9 P < 0.001). On a Visual Analogue scale, patients reported more pain at 4 hr (P < 0.001) and 8 hr (P < 0.001) in the Femostop group. The worst amount of pain at any time point was also more severe in the Femostop group (P < 0.001). Similar results were found on a Present Pain Intensity scale of pain. There were no differences in ultrasound-determined vascular complications (two each). Femoral access site closure using the AngioSeal device resulted in a small delay in leaving the angiography suite and a higher disposable cost compared to using the Femostop device. However, patients receiving the AngioSeal were able to ambulate sooner and reported less pain, which may justify the increased costs involved.
Location: No location found
Location: Spain
No related grants have been discovered for John CROZIER.