Clinical scientists can use a continuum of registration efforts that vary in their disclosure and timing relative to data collection and analysis. Broadly speaking, registration benefits investigators by offering stronger, more powerful tests of theory with particular methods in tandem with better control of long-run false positive error rates. Registration helps clinical researchers in thinking through tensions between bandwidth and fidelity that surround recruiting participants, defining clinical phenotypes, handling comorbidity, treating missing data, and analyzing rich and complex data. In particular, registration helps record and justify the reasons behind specific study design decisions, though it also provides the opportunity to register entire decision trees with specific endpoints. Creating ever more faithful registrations and standard operating procedures may offer alternative methods of judging a clinical investigator's scientific skill and eminence because study registration increases the transparency of clinical researchers' work.

Objective Pediatric bipolar disorder (PBD) involves a potent combination of mood dysregulation and interpersonal processes, placing these youth at significantly greater risk of suicide. We examined the relationship between suicidal behavior, mood symptom presentation, family functioning, and quality of life (QoL) in youth with PBD. Methods Participants were 138 youths aged 5–18 years presenting to outpatient clinics with DSM-IV diagnoses of bipolar I disorder (n = 27), bipolar II disorder (n = 18), cyclothymic disorder (n = 48), and bipolar disorder not otherwise specified (n = 45). Results Twenty PBD patients had lifetime suicide attempts, 63 had past or current suicide ideation, and 55 were free of suicide ideation and attempts. Attempters were older than nonattempters. Suicide ideation and attempts were linked to higher depressive symptoms, and rates were even higher in youths meeting criteria for the mixed specifier proposed for DSM-5. Both suicide ideation and attempts were associated with lower youth QoL and poorer family functioning. Parent effects (with suicidality treated as outcome) and child effects (where suicide was the predictor of poor family functioning) showed equally strong evidence in regression models, even after adjusting for demographics. Conclusions These findings underscore the strong association between mixed features and suicidality in PBD, as well as the association between QoL, family functioning, and suicidality. It is possible that youths are not just a passive recipient of family processes, and their illness may play an active role in disrupting family functioning. Replication with longitudinal data and qualitative methods should investigate both child and parent effect models.

Youths with bipolar disorder reported lower quality of life than other youths encountered in pediatric practice. Pediatricians should attend not only to the child's mood symptoms but also to the overall impairment of the disorder.

The overarching goal of this review is to examine the current best evidence for assessing bipolar disorder in children and adolescents and provide a comprehensive, evidence-based approach to diagnosis. Evidence-based assessment strategies are organized around the "3 Ps" of clinical assessment: Predict important criteria or developmental trajectories, Prescribe a change in treatment choice, and inform Process of treating the youth and his/her family. The review characterizes bipolar disorder in youths -specifically addressing bipolar diagnoses and clinical subtypes; then provides an actuarial approach to assessment -using prevalence of disorder, risk factors, and questionnaires; discusses treatment thresholds; and identifies practical measures of process and outcomes. The clinical tools and risk factors selected for inclusion in this review represent the best empirical evidence in the literature. By the end of the review, clinicians will have a framework and set of clinically useful tools with which to effectively make evidence-based decisions regarding the diagnosis of bipolar disorder in children and adolescents.There have been radical changes in our scientific understanding and clinical practices around the diagnosis of bipolar disorder in children and adolescents. Whereas the condition used to seldom be diagnosed before puberty, there has been a recent surge in rates of diagnosis such that a large proportion of psychiatrically hospitalized youths now carry clinical diagnoses of bipolar disorder 1 , and there has been a more than 40 fold increase in rates of diagnoses over a 10-year period 2 . There has been debate about whether the increase in diagnosis is primarily due to a correction of previous under-diagnosis, versus concerns that it is now overdiagnosed or even a case of "diseasemongering" 3 . Discussion has also focused on whether bipolar disorder in youth is the same illness as in adults, versus representing a different condition or perhaps a pediatric subtype [4][5][6] . Although the topic is still portrayed as controversial in the popular media, at this point more than 350 peerreviewed publications have investigated different aspects of pediatric bipolar illness 7 . Growing evidence from clinical and epidemiological studies around the world indicates that bipolar disorder often first manifests in adolescence or earlier 8,9 , and many apparent differences between adult and child presentations appear to be an artifact of definitional issues and not real variations in clinical presentation 7 . Prospective longitudinal studies also are documenting moderate to high levels of developmental continuity with adult bipolar disorder [10][11][12] . All lines of evidence strongly indicate that bipolar symptoms in youths are associated with considerable impairment and warrant clinical attention.The goal of the present review is to provide a step-by-step, evidence-based approach to the assessment of bipolar disorder in children and adolescents. The review is organized around clinical decision-making and the...

OBJECTIVE To evaluate screening cystoscopy as the long‐term follow up in patients with an enterocystoplasty for ≥10 years. PATIENTS AND METHODS We performed a prospective analysis of 92 consecutive patients who attended our endoscopy suite for regular check cystoscopy as per standard follow‐up. This is performed for all patients with cystoplasty performed at our institute after 10 years. The data were recorded on patient demographics, original diagnosis and type of cystoplasty. In all, 53 of these patients consented to undergo bladder biopsies at the same time. RESULTS The median (range) follow‐up was 15 (10–33) years. No cancer was identified with either surveillance cystoscopy or on routine biopsies. Chronic inflammation was identified in 25 biopsies (27%). Villous atrophy was present in 12 (55%) ileal patch and three (12.5%) colonic patch biopsies. During this study, the first and only case of malignancy in a cystoplasty at our institution was diagnosed in a symptomatic patient. She had intermittent haematuria and recurrent urinary tract infections (UTIs). She previously had a normal surveillance cystoscopy. CONCLUSIONS We feel that it is not necessary to perform yearly check cystoscopies in patients with augmented bladders at least in the first 15 years, as cancer has not yet been detected with surveillance cystoscopy in this patient group. However, if the patient develops haematuria or other worrisome symptoms including suprapubic pain and recurrent unexplained UTIs a full evaluation, including cystoscopy and computerized tomography should be undertaken.