Self-report versus performance based executive functioning in people with psychotic disorders.

Background: Although executive functioning is often measured using performance-based measures, these measures have their limits, and self-report measures may provide added value. Especially since these two types of measures often do not correlate with one another. It thus has been proposed they might measure different aspects of the same construct. To explore the differences between a performance-based measure of executive functioning and a self-report measure, we examined their associations in patients with a psychotic disorder with the following: other neurocognitive measures; psychotic symptoms; anxiety and depression symptoms, and daily-life outcome measures. Method: This cross-sectional study consisted of baseline measures collected as part of a cohort study of people with a psychotic disorder (the UP'S study; n = 301). The Behavioral Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used to assess self-rated executive functioning, and the Tower of London (TOL) to assess performance-based executive functioning. Generalized linear models (GLM) were used with the appropriate distribution and link function to study the associations between TOL and BRIEF-A, and the other variables, including the Brief Assessment of Cognition in Schizophrenia (BACS), the Positive and Negative Symptoms Scale-Remission (PANSS-R), the General Anxiety Disorder - 7 (GAD-7), the Patient Health Questionnaire - 9 (PHQ-9) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Model selection was based on the Wald test. Results: The TOL was associated with other neurocognitive measures, such as verbal list learning (ß = 0.24), digit sequencing (ß = 0.35); token motor task (ß = 0.20); verbal fluency (ß = 0.24); symbol coding (ß = 0.43); and a screener for intelligence (ß = 2.02). It was not associated with PANNS-R or WHO-DAS scores. In contrast, the BRIEF-A was associated not with other neurocognitive measures, but with the PANSS-R (ß = 0.32); PHQ-9 (ß = 0.52); and GAD-7 (ß = 0.55); and with all the WHODAS domains: cognition domain (ß = 0.54), mobility domain (ß = 0.30) and selfcare domain (ß = 0.22). Conclusion: Performance-based and self-report measures of executive functioning measure different aspects of executive functioning. Both have different associations with neurocognition, symptomatology and daily functioning measures. The difference between the two instruments is probably due to differences in the underlying construct assessed.

Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care.

INTRODUCTION: Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. METHODS: This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were: C­statistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact. RESULTS: We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (n = 235), of which acute coronary syndrome accounted for 6.8% (n = 98). For predicting major events, C­statistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval: 0.70-0.77) and 0.76 (0.73-0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62-0.69). All had appropriate calibration. Both scores (at threshold ≥ 2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS. CONCLUSION: Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.

Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care.

BACKGROUND: Chest pain is a common symptom in urgent primary care. The distinction between urgent and non-urgent causes can be challenging. A modified version of the HEART score, in which troponin is omitted ('simplified HEART') or replaced by the so-called 'sense of alarm' (HEART-GP), may aid in risk stratification. METHOD: This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale, out-of-hours, regional primary care facility in the Netherlands, with 6­week follow-up for major adverse cardiac events (MACEs). The outcome of interest is diagnostic accuracy, including positive predictive value (PPV) and negative predictive value (NPV). RESULTS: We included 664 patients; MACEs occurred in 4.8% (n = 32). For  simplified HEART and HEART-GP, we found C­statistics of 0.86 (95% confidence interval (CI) 0.80-0.91) and 0.90 (95% CI 0.85-0.95), respectively. Optimal diagnostic accuracy was found for a simplified HEART score ≥2 (PPV 9%, NPV 99.7%), HEART-GP score ≥3 (PPV 11%, NPV 99.7%) and HEART-GP score ≥4 (PPV 16%, NPV 99.4%). Physicians referred 157 patients (23.6%) and missed 6 MACEs. A simplified HEART score ≥2 would have picked up 5 cases, at the expense of 332 referrals (50.0%, p < 0.001). A HEART-GP score of ≥3 and ≥4 would have detected 5 and 3 MACEs and led to 293 (44.1%, p < 0.001) and 186 (28.0%, p = 0.18) referrals, respectively. CONCLUSION: HEART-score modifications including the physicians' 'sense of alarm' may be used as a risk stratification tool for chest pain in primary care in the absence of routine access to troponin assays. Further validation is warranted.

[Summary of the practice guideline 'The red eye' (first revision) of the Dutch College of General Practitioners (NHG)]. / Samenvatting van de standaard 'Het rode oog' (eerste herziening) van het Nederlands Huisartsen Genootschap.

The revised NHG-guideline 'The red eye' provides recommendations for the diagnosis and therapy in patients with a red eye. In the presence of pain, decreased visual acuity and photophobia (alarm symptoms) should be considered as sight threatening conditions. In most instances a red eye results from conjunctivitis. The complaint of (an) early morning glued eye(s) makes a bacterial origin of acute infectious conjunctivitis more likely. Itching and a history of infectious conjunctivitis make the probability of bacterial involvement less likely. The type of discharge does not help to adequately distinguish bacterial from viral conjunctivitis. Since an infectious conjunctivitis is a self-limiting condition, no treatment is necessary as a rule. Antibiotic treatment is only rational if conjunctivitis is (most probably) caused by bacteria. It has to be considered only if a patient suffers from much discomfort, if complaints do not begin to decline after 3 days and in patients with preexisting corneal defects. Because of widespread resistance to fusidic acid this should in principle not be prescribed for treatment of conjunctivitis; chloramphenicol is still the drug of choice. During revision of the guideline discussions concentrated on 2 aspects: the position of slit lamp biomicroscopy in general practice and giving a patient with keratoconjunctivitis photoelectrica the remainder of a 'minim' with anaesthetic eye drops. Regarding both topics it was decided not to change the recommendations of the former version of the guideline: the use of slit lamp biomicroscopy remains optional for general practitioners and it remains permitted to give the remainder of a 'minim' with anaesthetic eye drops to a patient with keratoconjunctivitis photoelectrica.

[From the Cochrane Library: Marginally higher chance of cure by antibiotic treatment in acute bacterial conjunctivitis]. / Uit de Cochrane Library: Marginaal grotere genezingskans door antibioticabehandeling bij acute bacteriële conjunctivitis.

Acute bacterial conjunctivitis is one of the most frequently encountered ocular disorders in primary care. It is frequently self-limiting, and the widespread use of broad-spectrum antibiotics has led to concerns regarding antibiotic resistance. Therefore, a Cochrane systematic review of 5 randomised clinical trials that compared antibiotic treatment with placebo in patients with acute bacterial conjunctivitis was recently updated. The chances of clinical and microbiological benefits of topical antibiotics were small but statistically significantly higher compared with placebo in the early stage (2 to 5 days after the first day of the intervention) and late stage (6 to 10 days after the first day of the intervention). The risk of adverse events in patients treated with placebo appeared to be low. Future trials should assess the cost-effectiveness of antibiotic treatment for acute bacterial conjunctivitis.

Somaclonal variation in tuber disc-derived populations of potato. II. Differential effect of genotype.

Three somaclonal populations of potato (Solanum tuberosum L.), each comprised of at least 1,000 plants, were regenerated from the cultivars Kennebec, Russet Burbank, and Superior. The frequency of formation of adventitious meristems from tuber disc explants varied significantly between these potato genotypes. Only 1.0-1.3% of each somaclonal population exhibited morphological aberrations. Regenerated populations of 'Kennebec' and 'Superior', when compared to respective control populations over three asexual generations, were similarly enriched with somaclones having more elongated tubers, a higher total tuber number and weight, a higher cull tuber number and weight, and earlier maturity. Somaclones of 'Russet Burbank' also produced more elongated tubers, a higher total tuber number, and a higher cull tuber number and weight but, in contrast, these somaclones were lower in total tuber weight, lower in U.S. 1 tuber number and weight, shorter in stem length, and lower in vigor. Of the three cultivars, 'Russet Burbank' somaclones possessed the greatest variability for most traits. Besides this significant genotype effect, quantitative traits differed amongst each other in respect of relative changes resulting from somaclonal variation. Observed differences among genotypes and quantitative traits will undoubtedly affect the success or failure of plant improvement programs attempting to utilize somaclonal variation.

Somaclonal variation in tuber disc-derived populations of potato : I. Evidence of genetic stability across tuber generations and diverse locations.

Approximately 1,600 potato (Solanum tuberosum L.) plants of the cultivar 'Superior' were regeneratedin vitro from meristems adventitiously initiated on tuber disc expiants. Direct regeneration from tuber disc cells, by passing a callus intermediary, is efficient and results in low frequencies of plants with gross phenotypic aberrations. The somaclonal plant population was statistically characterized in field plots over five asexual generations and in three diverse locations. When compared in advanced generations to a large population of control plants propagated from stem cuttings, the means of the somaclonal population were significantly different, often shifted in the desirable direction, for 16 of 22 horticulturally important traits. Somaclonal population variances statistically exceeded those of the controls for 13 of the 22 traits. Regressions between consecutive tuber generations and between locations or replications (blocks) within a generation were significant in the somaclonal population for all traits analyzed. In a few instances, significant control population regressions occurred that are interpreted to be the result of non-random, non-genetic factors primarily affecting control plants of low vigor. Selected somaclones exhibiting desirable alterations for yield, tuber number and shape, and vigor were stable over more than two consecutive asexual generations.