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Iverson G.L.,British Columbia Mental Health and Addiction Services | Iverson G.L.,University of British Columbia | Hakulinen U.,Medical Imaging Center | Waljas M.,University of Tampere | And 7 more authors.
Brain Injury | Year: 2011

Objective: A practical methodological issue for diffusion tensor imaging (DTI) researchers is determining what to do about incidental findings, such as white matter hyperintensities (WMHI). The purpose of this study was to compare healthy control subjects with or without WMHIs on whole brain DTI. Method: Participants were 30 subjects (age=37.7, SD=11.3, Range=18-60; 70% female) who had no known developmental, general medical, neurological or psychiatric condition that could have had an adverse affect on brain morphology. Results: MRI (3 Tesla) revealed, at minimum, a WMHI in eight subjects (26.7%). Fractional anisotropy (FA) was calculated for 19 regions of interest (ROI). Frequency distributions of FA scores for the 19 ROIs were calculated. The 10th percentile for each ROI was selected as a cut-off score. Having four or more low FA scores occurred in 16.7%. More subjects with incidental findings met criterion for low FA scores (37.5%), compared to 9.1% of subjects with no findings. When subjects with minor WMHIs were retained and only those with multiple incidental findings were excluded, 8.3% of the retained subjects met criterion for low FA scores compared to 50.0% of the excluded subjects. Conclusions: The decision to include or exclude subjects who have incidental findings can influence the results of a study. © 2011 Informa UK Ltd All rights reserved. Source

Hart S.L.,Ryerson University | Hart S.L.,Zane Cohen Center for Digestive Diseases | Torbit L.A.,Ryerson University | Crangle C.J.,Ryerson University | And 7 more authors.
Psycho-Oncology | Year: 2012

Objectives Although the hereditary breast and ovarian cancer literature has demonstrated short-term gains in psychological adjustment following genetic counseling, there has been limited research examining long-term outcomes and moderators. Moreover, there has been minimal research into the psychological effects of this intervention in populations at high risk for pancreatic cancer. This study examines the long-term effects of pancreatic cancer screening and genetic counseling on cancer-related distress and cancer worry in a high-risk population at 1-year follow-up. Additionally, this study explores potential moderators of the effectiveness of this intervention. Methods One hundred twenty-nine participants with familial pancreatic cancer or with the BRCA2 gene mutation completed a baseline questionnaire prior to their first pancreatic cancer screening and genetic counseling session. Participants also completed questionnaires at 3- and 12-month follow-up. Results Cancer-related intrusive thoughts decreased significantly over time, whereas cancer-related worry decreased at 3 months and showed a small but significant increase at 1 year. Age and baseline distress exhibited moderator effects. Younger individuals showed a significant decrease in cancer-related intrusive thoughts, cancer-related avoidant thoughts, and cancer worry. Additionally, individuals with greater baseline distress showed a significant decrease in cancer-related intrusive thoughts over time. Conclusions Analysis of the long-term effects of pancreatic cancer screening and genetic testing reveal psychological gains that are maintained at 1-year follow-up. This intervention is particularly effective for younger participants and individuals with greater baseline distress. Copyright © 2011 John Wiley & Sons, Ltd. Source

Iverson G.L.,British Columbia Mental Health and Addiction Services | Iverson G.L.,University of British Columbia | Brooks B.L.,Alberta Childrens Hospital | Brooks B.L.,University of Calgary | And 2 more authors.
Journal of Affective Disorders | Year: 2011

Background: We hypothesized that only a minority of patients with mood disorders have measurable cognitive impairment, and this minority drives the small-to-medium effect sizes detected in group studies. Removal of this minority from group statistical analyses will illustrate that the majority appear to have broadly normal cognitive functioning. Methods: Participants were adults between the ages of 20 and 54, including 659 healthy control subjects, 84 unmedicated outpatients diagnosed with depression, 59 outpatients diagnosed with depression who were on medications at the time of the evaluation, and 43 outpatients with bipolar disorder. All completed the CNS Vital Signs computerized cognitive screening battery. Results: The prevalence rates of low cognitive test scores were calculated for the healthy control subjects and the patients with mood disorders. Having two scores at or below the 5th percentile occurred in 31.2% of the patients and only 8.2% of the control subjects [χ2(1) = 66.67, p <.0001; Odds Ratio = 5.1, 95% CI = 3.4-7.7]. For the control subjects, this low false positive rate for cognitive impairment was maintained across age groups, sexes, and education levels. A larger proportion of patients with bipolar disorder (41.9%) than patients with depression (27.1-28.6%) met this criterion for cognitive impairment. Conclusions: This study suggests that cognitive impairment associated with mood disorders is limited to a minority of patients with the majority being broadly cognitively normal. Future research should determine if this identified subgroup has neuroanatomical, neurophysiological, or neuroendocrine abnormalities. Cognitive screening tools of this type might be useful in selecting participants for studies. © 2011 Elsevier B.V. All rights reserved. Source

Brickell T.A.,British Columbia Mental Health and Addiction Services | Brickell T.A.,Defense and Veterans Brain Injury Center | McLean C.,British Columbia Mental Health and Addiction Services | McLean C.,Simon Fraser University
Journal of Patient Safety | Year: 2011

Objectives: It is only recently that patient safety in mental health was considered a field in its own right, and there is a lack of awareness of the issues and a shortage of readily available information. This research builds on existing knowledge by soliciting the expertise of leaders in the area of patient safety and/or mental health via 2 qualitative methods. Methods: Qualitative interviews were held with 19 key informants. Small group discussions were held during a Canadian invitational roundtable event with 72 participants. A thematic qualitative analysis involving a 2-step process was performed: (1) coding each interview, and (2) identifying larger themes. Results: The findings revealed that more work is required to establish clear patient safety definitions, develop awareness, set priorities, and develop strategies for responding to patient safety incidents in mental health settings. Establishing a culture of patient safety and embedding it within all levels of an organization is vital, including adopting a systems level approach to examining patient safety incidents, encouraging open reporting and communication, considering the patient/caregiver perspective, and eliminating discrimination and stigma. Patient safety issues pertaining to community care settings are an urgent issue and require greater understanding. The need to promote national leadership, standardization of practice, ongoing training, information sharing, and additional research also was voiced. Conclusions: The results from this research highlight that greater action is required to improve patient safety in mental health settings. This research has identified several potentially important future directions for improving patient safety in mental health. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Petersen K.L.,British Columbia Mental Health and Addiction Services | Petersen K.L.,University of British Columbia | Nicholls T.L.,British Columbia Mental Health and Addiction Services | Nicholls T.L.,University of British Columbia | And 7 more authors.
Schizophrenia Research | Year: 2013

Objective: The objective of this study is to assess the clinical and social outcomes for a cohort of patients who were part of the redevelopment of psychiatric services in British Columbia. Method: This study used a naturalistic, quasi-experimental design, to examine the outcomes of a cohort of 189 long-stay patients at Riverview Hospital (RVH), some of whom moved into Tertiary Psychiatric Residential Facilities (TPRFs), some into the community in less structured facilities, and some remained at RVH. Data was collected from clinical files at RVH and at each participating site, semi-structured interviews and self-report measures were completed with patients. In addition, semi-structured interviews were also conducted with staff members. Results: There was very minimal evidence of transinstitutionalization to prisons or homelessness; one participant resided in a correctional facility, one resided in a forensic facility, and one participant spent some time homeless. In addition, the majority of participants remained in residences that provided 24. h care. Eighty percent of our population was diagnosed with a schizophrenia spectrum disorder. Psychiatric symptoms remained fairly stable; some embarrassing social behaviors increased; however, aggressive behaviors showed no increase; neuropsychological deficits did not deteriorate, there were even some improvements. Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life. Conclusions: This study builds on existing research demonstrating that well-planned and appropriately resourced hospital closures can lead to positive psycho-social outcomes for participants and can successfully avoid negative outcomes such as transinstitutionalization to the judiciary system and homelessness. © 2013 Elsevier B.V. Source

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