The prevalence rates of depression in congestive heart failure patients range from 24%-42%. Depression is a graded, independent risk factor for readmission to the hospital, functional decline, and mortality in patients with congestive heart failure. Physicians can assess depression by using the SIG E CAPS + mood mnemonic, or any of a number of easily administered and scored self-report inventories. Cognitive-behavior therapy is the preferred psychological treatment. Cognitive-behavior therapy emphasizes the reciprocal interactions among physiology, environmental events, thoughts, and behaviors, and how these may be altered to produce changes in mood and behavior. Pharmacologically, the selective serotonin reuptake inhibitors are recommended, whereas the tricyclic antidepressants are not recommended for depression in congestive heart failure patients. The combination of a selective serotonin reuptake inhibitor with cognitive-behavior therapy is often the most effective treatment.

The purpose of this study was to obtain information about education in substance use and dependence that appears in the predoctoral curricula of U.S. and Canadian dental schools. Sixty-eight deans were sent a twenty-item survey requesting information about when in the curriculum these subjects were taught, what instructional methods were used, and whether behavior change instruction was included to address these issues in clinical interactions. The survey had an 81 percent response rate. The topics of alcohol use and dependence, tobacco use and dependence, and prescription drug misuse and abuse were reported in over 90 percent (N=55) of responding schools' predoctoral curricula. The topic of other substance use and dependence was reported in only 72.7 percent (N=40) of these schools. The primary instructional method reported was the use of lecture. Less frequently used methods included small-group instruction, instruction in school-based clinic, community-based extramural settings, and independent study. As future health professionals, dental students are an important source for patients concerning substance use, abuse, and treatment. Our investigation conirmed that alcohol, tobacco, and prescription drug abuse is addressed widely in predoctoral dental curricula, but other substance use and dependence are less frequently addressed. Dr. Huggett is Assistant

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This chapter outlines the guidance on generalised anxiety disorder. It provides a clear overview for the junior doctor in a clinical setting.

The purpose of this study was (1) to introduce an endoscopic technique for performing otoplasty; (2) to compare the durability of folding with scoring, sutures, or abrasion; and (3) to study the histologic changes associated with three techniques. Thirteen adult New Zealand White rabbits (26 ears) were divided into three otoplasty groups: bent cartilage (nine ears), cut cartilage (nine ears), or endoscopic abrasion of cartilage (eight ears). In all three groups, the ears were folded using external mattress sutures, with a transverse 180-degree fold. Sutures were removed at 1 to 6 weeks, and the ears followed for 4 weeks postoperatively. Ear-folding angles were followed weekly from suture removal to 4 weeks postoperatively. After sacrifice, the ear cartilage was harvested for histologic analysis. The ears were maintained in a 180-degree ventral fold by splinting sutures, which were removed at various times. Four weeks after suture removal, the mean ear angles were 13 degrees in the bent (control) group, 84 degrees in the cut group, and 132 degrees in the abraded group. The differences between the abraded and cut versus bent groups were significant (p = 0.0001 and 0.0073, respectively). There was no significant difference between the abraded versus cut groups. Histologic analysis showed perichondrial thickening on the convex surface in all of the groups. Fibrocartilage was produced in the cut and abraded groups. Based on histologic observation, the repair cartilage in the cut group was more fibrous, whereas that in the endoscopic group was more abundant with marked degenerative changes in the central zone. A new method of percutaneous endoscopic otoplasty in the rabbit model is described. This study showed that endoscopic otoplasty produced folding that was well maintained during the study period.