1
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Ioannidis JPA. Inverse publication reporting bias favouring null, negative results. BMJ Evid Based Med 2024; 29:6-9. [PMID: 37315987 DOI: 10.1136/bmjebm-2023-112292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
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2
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Gklinos P, Mitsikostas DD. Migraine in multiple sclerosis patients: potential links and treatment approach. Expert Opin Pharmacother 2023; 24:1845-1851. [PMID: 37807822 DOI: 10.1080/14656566.2023.2262384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Migraine has been reported to be twice as prevalent in patients with multiple sclerosis (MS) compared to the non-MS population. However, prospective, controlled studies that could lead to robust conclusions are still lacking. AREAS COVERED Treatment of migraine in patients with MS can be challenging. Comorbidities need to be assessed and managed early, and preventive treatment should be initiated when indicated. Caution is warranted regarding the selection of the preventive medication since certain agents can magnify MS symptoms and particularly cognitive symptoms. This paper aims to discuss the association of MS and migraine, shed light on distinguishing points and red flags, as well as offer practical advice on the selection of treatment according to patients' characteristics. EXPERT OPINION A holistic approach including pharmacological and non-pharmacological modifications is required to treat migraine in patients with MS effectively. Anti-CGRP monoclonal antibodies are a promising option due to limited drug-to-drug interactions; however, larger prospective studies are required to draw robust conclusions on the concomitant use of anti-CGRPs with MS disease modifying treatments. Early migraine preventive treatment might be needed to reduce the burden of disease in patients with MS.
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Affiliation(s)
- Panagiotis Gklinos
- Department of Neurology, Aeginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos-Dimitrios Mitsikostas
- Department of Neurology, Aeginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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3
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Thong EHE, Quek EJW, Loo JH, Yun CY, Teo YN, Teo YH, Leow AST, Li TYW, Sharma VK, Tan BYQ, Yeo LLL, Chong YF, Chan MY, Sia CH. Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review. BIOLOGY 2023; 12:1154. [PMID: 37627038 PMCID: PMC10452707 DOI: 10.3390/biology12081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer's Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.
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Affiliation(s)
- Elizabeth Hui En Thong
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Ethan J. W. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Jing Hong Loo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Choi-Ying Yun
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Yao Hao Teo
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Aloysius S. T. Leow
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Tony Y. W. Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Vijay K. Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Benjamin Y. Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Leonard L. L. Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Yao Feng Chong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Mark Y. Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
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4
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Yang M, Sun D, Wang Y, Yan M, Zheng J, Ren J. Cognitive Impairment in Heart Failure: Landscape, Challenges, and Future Directions. Front Cardiovasc Med 2022; 8:831734. [PMID: 35198608 PMCID: PMC8858826 DOI: 10.3389/fcvm.2021.831734] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 12/20/2022] Open
Abstract
Heart failure (HF) is a major global healthcare problem accounting for substantial deterioration of prognosis. As a complex clinical syndrome, HF often coexists with multi-comorbidities of which cognitive impairment (CI) is particularly important. CI is increasing in prevalence among patients with HF and is present in around 40%, even up to 60%, of elderly patients with HF. As a potent and independent prognostic factor, CI significantly increases the hospitalization and mortality and decreases quality of life in patients with HF. There has been a growing awareness of the complex bidirectional interaction between HF and CI as it shares a number of common pathophysiological pathways including reduced cerebral blood flow, inflammation, and neurohumoral activations. Research that focus on the precise mechanism for CI in HF is still ever insufficient. As the tremendous adverse consequences of CI in HF, effective early diagnosis of CI in HF and interventions for these patients may halt disease progression and improve prognosis. The current clinical guidelines in HF have begun to emphasize the importance of CI. However, nearly half of CI in HF is underdiagnosed, and few recommendations are available to guide clinicians about how to approach CI in patients with HF. This review aims to synthesize knowledge about the link between HF and cognitive dysfunction, issues pertaining to screening, diagnosis and management of CI in patients with HF, and emerging therapies for prevention. Based on data from current studies, critical gaps in knowledge of CI in HF are identified, and future research directions to guide the field forward are proposed.
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Affiliation(s)
- Mengxi Yang
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Di Sun
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yu Wang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Mengwen Yan
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jingang Zheng
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jingyi Ren
- Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- Vascular Health Research Center of Peking University Health Science Center, Beijing, China
- *Correspondence: Jingyi Ren
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Alcala V, Johnson K, Steele C, Wu J, Zhang D, Pashler H. The tainted altruism effect: a successful pre-registered replication. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211152. [PMID: 35116147 PMCID: PMC8790362 DOI: 10.1098/rsos.211152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Newman and Cain (Newman, Cain 2014 Psychol. Sci. 25, 648-655 (doi:10.1177/0956797613504785)) reported that observers view a person's choices as less ethical when that person has acted in response to both altruistic and selfish (commercial) motivations, as compared with purely selfish interests. The altruistic component reduces the observers' approval rather than raising it. This puzzling phenomenon termed the 'tainted altruism' effect, has attracted considerable interest but no direct replications in prior research. We report direct replications of Newman and Cain's Experiments 2 and 3, using a larger sample (n = 501) intended to be fairly representative of the US population. The results confirm the original findings in considerable detail.
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Affiliation(s)
- Valerie Alcala
- Department of Psychology, University of California, San Diego, 9300 Gilman Drive, La Jolla, CA 92093, USA
| | - Kendra Johnson
- Department of Psychology, University of California, San Diego, 9300 Gilman Drive, La Jolla, CA 92093, USA
| | - Caroline Steele
- Department of Psychology, University of California, San Diego, 9300 Gilman Drive, La Jolla, CA 92093, USA
| | - Juanshu Wu
- Department of Psychology, University of California, San Diego, 9300 Gilman Drive, La Jolla, CA 92093, USA
| | - Donglai Zhang
- Department of Psychology, University of California, San Diego, 9300 Gilman Drive, La Jolla, CA 92093, USA
| | - Harold Pashler
- Department of Psychology, University of California, San Diego, 9300 Gilman Drive, La Jolla, CA 92093, USA
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Lengton R, W Schouten R, Nadort E, van Rossum EFC, Dekker FW, Siegert CEH, Hoogeveen EK. Association Between Lipophilic Beta-Blockers and Depression in Diabetic Patients on Chronic Dialysis. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221119446. [PMID: 36061232 PMCID: PMC9434677 DOI: 10.1177/11795514221119446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Depression is associated with lower quality of life and increased risk of
mortality. The prevalence of depression in chronic dialysis patients, as
well as in patients with diabetes, is more than 20%. It is debated whether
use of beta-blockers increases the risk of depression. Therefore, we
examined in chronic dialysis patients with and without diabetes, the
association between beta-blockers and depressive symptoms. Methods: Data were collected from the DIVERS-I study, a multicentre prospective cohort
among chronic dialysis patients in the Netherlands. Depressive symptoms were
assessed with the Beck Depression Inventory (BDI-II). We defined depressive
symptoms as a BDI-II score ⩾16. The cross-sectional association at baseline
between depressive symptoms and beta-blocker use in chronic dialysis
patients, was studied by multivariable logistic regression adjusted for
potential confounders. Results: We included 684 chronic dialysis patients, of whom 43% had diabetes mellitus,
and 57% used a beta-blocker of which 97% were lipophilic. After
multivariable adjustment, the OR (95% CI) for depressive symptoms in
patients with compared to without diabetes was 1.41 (1.00-1.98), and in
beta-blocker users compared to non-users 1.12 (0.80-1.56), respectively.
Dialysis patients with diabetes and beta-blocker use compared to those
without diabetes and not using beta-blockers had an OR of 1.73 (1.12-2.69)
for depressive symptoms. The association was stronger in dialysis patients
with diabetes and lipophilic beta-blocker use with an OR of 1.77
(1.14-2.74). Conclusions: We found a possible association between lipophilic beta-blocker use and
depressive symptoms in chronic dialysis patients with diabetes.
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Affiliation(s)
- Robin Lengton
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robbert W Schouten
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, OLVG hospital, Amsterdam, The Netherlands
| | - Els Nadort
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, OLVG hospital, Amsterdam, The Netherlands
| | - Elisabeth FC van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carl EH Siegert
- Department of Nephrology, OLVG hospital, Amsterdam, The Netherlands
| | - Ellen K Hoogeveen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
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7
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Shaw RJ, Mackay D, Pell JP, Padmanabhan S, Bailey DS, Smith DJ. The relationship between antihypertensive medications and mood disorders: analysis of linked healthcare data for 1.8 million patients. Psychol Med 2021; 51:1183-1191. [PMID: 31973782 PMCID: PMC8188528 DOI: 10.1017/s0033291719004094] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD). METHOD Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009-2016) and hospital admission (1981-2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression. RESULTS For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04-1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45-2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30-0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD. CONCLUSIONS There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.
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Affiliation(s)
- Richard J. Shaw
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David S. Bailey
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Daniel J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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8
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Riemer TG, Villagomez Fuentes LE, Algharably EAE, Schäfer MS, Mangelsen E, Fürtig MA, Bittner N, Bär A, Zaidi Touis L, Wachtell K, Majic T, Dinges MJ, Kreutz R. Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy. Hypertension 2021; 77:1539-1548. [PMID: 33719510 DOI: 10.1161/hypertensionaha.120.16590] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Thomas G Riemer
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany.,Department of Psychiatry and Psychotherapy (T.G.R., T.M.), Berlin Institute of Health, Germany
| | - Linda E Villagomez Fuentes
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Engi A E Algharably
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Marie S Schäfer
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Eva Mangelsen
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Marc-Alexander Fürtig
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Nadine Bittner
- Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Psychiatrie, Psychotherapie, Psychosomatik, Berlin, Germany (N.B., M.J.D.)
| | - Annalena Bär
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Laila Zaidi Touis
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | | | - Tomislav Majic
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Department of Psychiatry and Psychotherapy (T.G.R., T.M.), Berlin Institute of Health, Germany
| | - Martin J Dinges
- Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Psychiatrie, Psychotherapie, Psychosomatik, Berlin, Germany (N.B., M.J.D.)
| | - Reinhold Kreutz
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany (R.K.)
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9
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Prediction of Major Depressive Disorder Following Beta-Blocker Therapy in Patients with Cardiovascular Diseases. J Pers Med 2020; 10:jpm10040288. [PMID: 33352870 PMCID: PMC7766565 DOI: 10.3390/jpm10040288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022] Open
Abstract
Incident depression has been reported to be associated with poor prognosis in patients with cardiovascular disease (CVD), which might be associated with beta-blocker therapy. Because early detection and intervention can alleviate the severity of depression, we aimed to develop a machine learning (ML) model predicting the onset of major depressive disorder (MDD). A model based on L1 regularized logistic regression was trained against the South Korean nationwide administrative claims database to identify risk factors for the incident MDD after beta-blocker therapy in patients with CVD. We identified 50,397 patients initiating beta-blockers for CVD, with 774 patients developing MDD within 365 days after initiating beta-blocker therapy. An area under the receiver operating characteristic curve (AUC) of 0.74 was achieved. A history of non-selective beta-blockers and factors related to anxiety disorder, sleeping problems, and other chronic diseases were the most strong predictors. AUCs of 0.62–0.71 were achieved in the external validation conducted on six independent electronic health records and claims databases in the USA and South Korea. In conclusion, an ML model that identifies patients at high-risk for incident MDD was developed. Application of ML to identify susceptible patients for adverse events of treatment may serve as an important approach for personalized medicine.
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Tambur AR, Campbell P, Chong AS, Feng S, Ford ML, Gebel H, Gill RG, Kelsoe G, Kosmoliaptsis V, Mannon RB, Mengel M, Reed EF, Valenzuela NM, Wiebe C, Dijke IE, Sullivan HC, Nickerson P. Sensitization in transplantation: Assessment of risk (STAR) 2019 Working Group Meeting Report. Am J Transplant 2020; 20:2652-2668. [PMID: 32342639 PMCID: PMC7586936 DOI: 10.1111/ajt.15937] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
The purpose of the STAR 2019 Working Group was to build on findings from the initial STAR report to further clarify the expectations, limitations, perceptions, and utility of alloimmune assays that are currently in use or in development for risk assessment in the setting of organ transplantation. The goal was to determine the precision and clinical feasibility/utility of such assays in evaluating both memory and primary alloimmune risks. The process included a critical review of biologically driven, state-of-the-art, clinical diagnostics literature by experts in the field and an open public forum in a face-to-face meeting to promote broader engagement of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics membership. This report summarizes the literature review and the workshop discussions. Specifically, it highlights (1) available assays to evaluate the attributes of HLA antibodies and their utility both as clinical diagnostics and as research tools to evaluate the effector mechanisms driving rejection; (2) potential assays to assess the presence of alloimmune T and B cell memory; and (3) progress in the development of HLA molecular mismatch computational scores as a potential prognostic biomarker for primary alloimmunity and its application in research trial design.
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Affiliation(s)
- Anat R. Tambur
- Department of SurgeryComprehensive Transplant CenterNorthwestern UniversityChicagoIllinoisUSA
| | - Patricia Campbell
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonCanada
| | - Anita S. Chong
- Section of TransplantationDepartment of SurgeryThe University of ChicagoChicagoIllinoisUSA
| | - Sandy Feng
- Department of SurgeryUCSF Medical CenterSan FranciscoCaliforniaUSA
| | - Mandy L. Ford
- Department of Surgery and Emory Transplant CenterEmory UniversityAtlantaGeorgiaUSA
| | - Howard Gebel
- Department of PathologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Ronald G. Gill
- Department of ImmunologyUniversity of ColoradoDenverColoradoUSA
| | - Garnett Kelsoe
- Department of ImmunologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | | | - Roslyn B. Mannon
- Department of MedicineDivision of NephrologyUniversity of Alabama School of MedicineBirminghamAlabamaUSA
| | - Michael Mengel
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonCanada
| | - Elaine F. Reed
- Department of Pathology and Laboratory MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Nicole M. Valenzuela
- Department of Pathology and Laboratory MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Chris Wiebe
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - I. Esme Dijke
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonCanada
| | - Harold C. Sullivan
- Department of PathologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Peter Nickerson
- Department of MedicineUniversity of ManitobaWinnipegManitobaCanada
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11
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Hamers PCM, Festen DAM, Hermans H. Non-pharmacological interventions for adults with intellectual disabilities and depression: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:684-700. [PMID: 29797730 DOI: 10.1111/jir.12502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although high rates of depression symptoms are reported in adults with intellectual disabilities (IDs), there is a lack of knowledge about non-pharmacological treatment options for depression in this population. The first research question of this paper is: Which non-pharmacological interventions have been studied in adults with ID and depression? The second research question is: What were the results of these non-pharmacological interventions? METHOD Systematic review of the literature with an electronic search in six databases has been completed with hand searches. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines have been followed. Selected studies met predefined inclusion criteria. RESULTS Literature search resulted in 4267 papers of which 15 met the inclusion criteria. Five different types of non-pharmacological interventions have been studied: cognitive behavioural therapy, behavioural therapy, exercise intervention, social problem-solving skills programme and bright light therapy. CONCLUSION There are only a few studies of good quality evaluating non-pharmacological interventions for adults with ID and depression. Some of these studies, especially studies on cognitive behavioural therapy, show good results in decreasing depressive symptoms. High-quality randomised controlled trials evaluating non-pharmacological interventions with follow-up are needed.
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Affiliation(s)
- P C M Hamers
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Hermans
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
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12
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Aizenstein HJ, Baskys A, Boldrini M, Butters MA, Diniz BS, Jaiswal MK, Jellinger KA, Kruglov LS, Meshandin IA, Mijajlovic MD, Niklewski G, Pospos S, Raju K, Richter K, Steffens DC, Taylor WD, Tene O. Vascular depression consensus report - a critical update. BMC Med 2016; 14:161. [PMID: 27806704 PMCID: PMC5093970 DOI: 10.1186/s12916-016-0720-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression". DISCUSSION This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed. CONCLUSION The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.
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Affiliation(s)
- Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrius Baskys
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Maura Boldrini
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Breno S Diniz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manoj Kumar Jaiswal
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
| | - Lev S Kruglov
- Department of Geriatric Psychiatry of the St. Petersburg Psychoneurological Research Institute named after V. M. Bekhterev, Medical Faculty of St. Petersburg University, St. Petersburg, Russia
| | - Ivan A Meshandin
- Clinical Department, Scientific and Practical Center of Psychoneurology named after V. M. Soloviev, St. Petersburg, Russia
| | - Milija D Mijajlovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Belgrade, Serbia
| | - Guenter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany
| | - Sarah Pospos
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Keerthy Raju
- Consultant in Old Age Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany.,Faculty for Social Sciences, Technical University of Nuremberg Georg Simon Ohm, Nuremberg, Germany
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Warren D Taylor
- Department of Psychiatry, The Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Veterans Affairs Medical Center, The Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Oren Tene
- Departments of Neurology and Psychiatry, Tel Aviv Medical Center, Tel Aviv, Israel.,Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Cravedi P. Rituximab in Membranous Nephropathy: Not All Studies Are Created Equal. Nephron Clin Pract 2016; 135:46-50. [PMID: 27676651 DOI: 10.1159/000450659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 12/31/2022] Open
Abstract
Many prospective studies and a recent randomized controlled trial have shown that the B-cell-depleting monoclonal antibody, rituximab, safely promotes the remission of nephrotic syndrome in approximately 65% of patients with membranous nephropathy (MN). Mechanistic studies have indicated that rituximab-induced proteinuria reduction is associated with clearance of anti-podocyte antigens phospholipase 2 receptor autoantibodies and subepithelial immune complexes, the hallmarks of the disease. A recently published study reported results which, at first sight, looked less favorable and implied that, due to a publication bias against negative results, the efficacy of rituximab in MN might be overestimated. Since patients received only one or 2 rituximab administrations, the authors suggest that when rituximab is used, higher doses and longer treatments should be considered. In this study, we highlight limitations of the study and warn against an oversimplified interpretation of the data. Though information on the optimal dose of rituximab to use in MN is still limited, available data from studies with predefined rituximab administration protocols collectively support the concept of titrating rituximab to the number of circulating B-cells that are invariably depleted after the first or second administration. Additional doses may increase the risk of adverse effects and related costs without augmenting efficacy. Importantly, underpowered studies with inconclusive results should not be confused with negative studies formally proving a neutral effect of a treatment. Until data from ad hoc designed clinical trials are available, the B-cell-driven protocol should be the preferred regimen, since it is similarly effective, but safer and more cost effective than other protocols employing multiple rituximab administrations.
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Affiliation(s)
- Paolo Cravedi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, N.Y., USA
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Initiation of β-blocker therapy and depression after acute myocardial infarction. Am Heart J 2016; 174:37-42. [PMID: 26995368 DOI: 10.1016/j.ahj.2015.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although β-blockers reduce mortality after acute myocardial infarction (AMI), early reports linking β-blocker use with subsequent depression have potentially limited their use in vulnerable patients. We sought to provide empirical evidence to support or refute this concern by examining the association between β-blocker initiation and change in depressive symptoms in AMI patients. METHODS Using data from 2 US multicenter, prospective registries of AMI patients, we examined 1-, 6-, and 12-month changes in depressive symptoms after the index hospitalization among patients who were β-blocker-naïve on admission. Depressive symptoms were assessed using the validated 8-item Patient Health Questionnaire (PHQ-8), which rates depressive symptoms from 0 to 24, with higher scores indicating more depressive symptoms. A propensity-matched repeated-measures linear regression model was used to compare change in depressive symptoms among patients who were and were not initiated on a β-blocker after AMI. RESULTS Of 3,470 AMI patients who were β-blocker-naïve on admission, 3,190 (91.9%) were initiated on a β-blocker and 280 (8.1%) were not. Baseline PHQ-8 scores were higher in patients not initiated on a β-blocker (mean 5.78 ± 5.45 vs 4.88 ± 5.11, P = .005). PHQ-8 scores were progressively lower at 1, 6, and 12 months in both the β-blocker (mean decrease at 12 months 1.16, P < .0001) and no-β-blocker groups (mean decrease 1.71, P < .0001). After propensity matching 201 untreated patients with 567 treated patients, initiation of β-blocker therapy was not associated with a difference in mean change in PHQ-8 scores at 1, 6, or 12 months after AMI (absolute mean difference with β-blocker initiation at 12 months of 0.08, 95% CI -0.81 to 0.96, P = .86). CONCLUSIONS Initiation of β-blocker therapy after AMI was not associated with an increase in depressive symptoms. Restricting β-blocker use because of concerns about depression appears unwarranted and may lead to undertreatment of AMI patients.
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Patwardhan AR. Ebola crisis in the United States: a glimpse of its larger shadow. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2014; 51:51/0/0046958014564055. [PMID: 25512226 PMCID: PMC5813631 DOI: 10.1177/0046958014564055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article is about readiness of the U.S. health care system to deal with crises. Using the Ebola crisis as a reference, first it examines the response to the current challenge. However, that is the smaller objective of the article. Lately, we are also being challenged to deal with other kinds of epidemics like obesity, mental health diseases, and violence. These crises are not dramatic like the Ebola crisis. However, these are no less insidious than Ebola. If we are not ready for them, then these crises have the potential to undermine the long-term health and prosperity of our society. In this context, and therefore mainly, this article is about two major long-standing systemic problems in the U.S. health care system that the unfolding of the Ebola crisis has bared. One is about how the inherent problem in the design of American federalist system regarding state autonomy on health matters is creating a dysfunctional health care system. The other is about the inertia of the research industry in the health care system in clinging to an archaic outdated inefficient mind-set and methodology that fails to generate the right information required for an appropriate decision making in matters of health care delivery, including crises. These problems are not small, nor their solutions easy. However, no matter how uncomfortable and tedious, facing them is necessary and inevitable. The discussions and arguments in this article are to outline their nature broadly and to make a call to further a dialogue.
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THOMASSEN Ø, STORESUND A, SØFTELAND E, BRATTEBØ G. The effects of safety checklists in medicine: a systematic review. Acta Anaesthesiol Scand 2014; 58:5-18. [PMID: 24116973 DOI: 10.1111/aas.12207] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Safety checklists have become an established safety tool in medicine. Despite studies showing decreased mortality and complications, the effects and feasibility of checklists have been questioned. This systematic review summarises the medical literature aiming to show the effects of safety checklists with a number of outcomes. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was used. All studies in which safety checklists were used as an additional tool designed to assure that an operation or task was performed as planned were included. RESULTS The initial search extracted 7408 hits. Twenty-nine articles met the inclusion criteria. Five additional studies were identified by a cross-referencing search. Four groups were made according to outcome measures. One group (n = 7) had 'hard' outcome measures, such as mortality and morbidity. The remaining studies, reporting 'softer' process-related measures, were divided into three categories: adherence to guidelines (n = 6), human factors (n = 16), and reduction of adverse events (n = 5). The main findings were improved communication, reduced adverse events, better adherence to standard operating procedures, and reduced morbidity and mortality. None of the included studies reported decreased patient safety or quality after introducing safety checklists. CONCLUSION Safety checklists appear to be effective tools for improving patient safety in various clinical settings by strengthening compliance with guidelines, improving human factors, reducing the incidence of adverse events, and decreasing mortality and morbidity. None of the included studies reported negative effects on safety.
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Affiliation(s)
- Ø. THOMASSEN
- Department of Anaesthesia and Intensive Care; Haukeland University Hospital; Bergen Norway
| | - A. STORESUND
- Department of Anaesthesia and Intensive Care; Haukeland University Hospital; Bergen Norway
| | - E. SØFTELAND
- Department of Anaesthesia and Intensive Care; Haukeland University Hospital; Bergen Norway
| | - G. BRATTEBØ
- Department of Anaesthesia and Intensive Care; Haukeland University Hospital; Bergen Norway
- Betanien University College; Bergen Norway
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Gelfand AA, Gelfand JM, Goadsby PJ. Migraine and multiple sclerosis: Epidemiology and approach to treatment. Mult Scler Relat Disord 2013; 2:73-9. [DOI: 10.1016/j.msard.2012.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 10/12/2012] [Accepted: 10/18/2012] [Indexed: 11/25/2022]
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18
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Coory M, White VM, Johnson KS, Hill DJ, Jefford M, Harrison S, Winship I, Millar J, Giles GG. Systematic review of quality improvement interventions directed at cancer specialists. J Clin Oncol 2013; 31:1583-91. [PMID: 23530093 DOI: 10.1200/jco.2012.46.0253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Summary evidence on the effectiveness of quality improvement interventions (QIIs) directed at cancer specialists is needed for two reasons. First, there are some innovations over which only cancer specialists have control (eg, surgical technique or chemotherapy regimen). Second, implementation of QIIs has opportunity costs; the time and money spent on an ineffective QII might be better spent on direct patient care. METHODS Medical Subject Headings and text words for "quality improvement" were combined with those for "neoplasm" to search MEDLINE, PsycINFO, CINAHL, and EMBASE from January 1990 to August 2012 for studies of QIIs directed at cancer specialists (eg, medical/radiation oncologist, surgeon). All study designs were included. RESULTS Five thousand seven hundred eighty-one articles were screened, but only 12 met the inclusion criteria, including three cluster randomized controlled trials (cRCTs), seven uncontrolled before-and-after comparisons, and two cross-sectional studies. All 12 studies were conducted in response to concerns about quality of care. No cRCT showed a benefit of the QIIs tested. Some uncontrolled before-and-after and cross-sectional studies reported a benefit from the QII, but these studies are difficult to interpret because of concerns about uncontrolled confounding. Interventions in all studies were multifaceted, but descriptions of different components were limited, and only one study examined their separate impact. CONCLUSION The published evidence about how to facilitate timely and consistent adoption of new clinical knowledge by cancer specialists into everyday clinical practice is thin. More investment is needed in research about the solution (QIIs) to match the investment in research about the problem (inconsistent/slow adoption of innovative cancer treatments).
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Affiliation(s)
- Michael Coory
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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