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Cornthwaite M, Turner K, Armstrong L, Boerkoel C, Chang C, Lehman A, Nikkel SM, Patel MS, Van Allen M, Langlois S. Impact of variation in practice in the prenatal reporting of variants of uncertain significance by commercial laboratories: NEED FOR GREATER ADHERENCE TO PUBLISHED GUIDELINES. Prenat Diagn 2022; 42:1514-1524. [PMID: 36068917 DOI: 10.1002/pd.6232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the impact of implementing commercial whole exome sequencing (WES) and targeted gene panel testing in pregnancies with fetal anomalies. METHODS A retrospective chart review of 124 patients with sequencing performed by commercial laboratories. RESULTS The diagnostic yield of WES and panel testing was 21.5% and 26% respectively, based on likely pathogenic (LP) or pathogenic (P) variants. Forty-two per cent of exomes and 32% of panels analyzed had one or more variant of uncertain significance (VUS) reported. A multidisciplinary in depth review of the fetal phenotype, disease phenotype, variant data, and, in some patients, additional prenatal or postnatal investigations increased the diagnostic yield by 5% for exome analysis and 6% for panel analysis. CONCLUSIONS The diagnostic yield of WES and panel testing combined was 23% based on LP and P variants. Although the reporting of VUS contributed to a 5% increase in diagnostic yield for WES and 6% for panels, the large number of VUS reported by commercial laboratories has significant resource implications. Our results support the need for greater adherence to the recommendations on the prenatal reporting of VUS and the importance of a multidisciplinary approach that brings together clinical and laboratory expertise in prenatal genetics and genomics. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- M Cornthwaite
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - K Turner
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - L Armstrong
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - C Boerkoel
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - C Chang
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - A Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - S M Nikkel
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - M S Patel
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - M Van Allen
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - S Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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Bessette L, Rahman P, Kelsall J, Purvis J, Rampakakis E, Lehman A, Rachich M, Nantel F, Marrache M, Asin Milan O. AB0357 INCIDENCE AND DETERMINANTS OF INFECTION IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH GOLIMUMAB IN REAL-WORLD PRACTICE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAlthough biologic use in rheumatoid arthritis (RA) has a well-characterized infections risk factor, most studies evaluating this association were conducted on first-generation anti-tumor necrosis factor (TNFi) agents or in early years post-drug development (early 2000).ObjectivesTo (i) characterize the long-term incidence of infection in a real-world cohort of RA patients treated with subcutaneous golimumab (GLM) in Canadian routine care; (ii) assess the impact of infections on GLM retention, and (iii) explore factors associated with the risk of infection.MethodsBioTRAC registry was a prospective, multicenter study that collected real-world clinical, laboratory, safety and patient-reported data from TNFi naïve patients or treated with biologics for a period of <6 months before enrolment. This post-hoc analysis included patients with RA who initiated GLM treatment. The incidence density rates (IDR) of total serious (SI) and non-serious (NSI) infections were calculated for the overall follow-up (90 months) period as well as by 6-month interval. Time to first infection and time to treatment discontinuation were assessed with the Kaplan-Meier estimator of the survival function. Determinants of infection over time or within the first 6 months were explored using generalized estimating equation models and logistic regression, respectively.Results530 patients were included with a mean (SD) age of 57.7 (13.0) years and disease duration of 8.0 (8.3) years. Of these, 404 (76.2%) were females, 74 (14.0%) were treated with ≤15mg/week MTX, 280 (52.8%) with >15mg/week MTX, while 173 (32.6%) were not on MTX. In terms of corticosteroids (CS), 72 (13.6%) were treated with ≤5mg/day, 63 (11.9%) with >5mg/day, and 391 (73.8%) were not on CS. Diabetes (4.5%), pulmonary disease (8.9%), and renal disease (18.5%) were present.Over a mean follow-up duration of 27.0 months, the IDR for total infections, NSI, and SI was 35.10 events/100 PYs, 32.90 events/100 PYs, and 2.23 events/100 PYs. Median estimated time to first infection was 52.9 months (SI: 84.9 months; NSI: 55.1 months) (Table 1). The incidence of total infections was 44.0, 37.3, 35.1, 29.4, 31.1, 35.7, 19.3 and 7.4 events/100 PYs at 0-6 months, 6-12 months, 12-24 months, 24-36 months, 36-48 months, 48-60 months, 60-72 months, 72-84 months, respectively and no infections between 84-90 months. In terms of determinants, no significant associations were identified for the incidence of infections within the first 6 months. However, presence of pulmonary disease was identified as a significant determinant of total infections (OR [95%CI]: 2.19 [1.36-3.52]) and NSI (2.22 [1.35-3.66]) over time, while higher age (1.08 [1.00-1.26]) and high (≥5 mg/day) CS dose (7.25 [1.12-46.80]) were associated with significantly higher odds of SI. Incidence of SI (6.48 [1.16-36.13]), but not NSI, was associated with significantly higher odds of GLM discontinuation; additional predictors of discontinuation were increased baseline CDAI (1.06 [1.04-1.08]) and use of concomitant MTX at low dose (0.52 [0.30-0.91]) or high dose (0.71 [0.49-1.04]).Table 1.Incidence Density Rate (IDR) by Infection Type.Infection TypeIDR (Events/100 PYs)Median Time to 1st Infection (months)Total Infections35.152.9Non-serious Infections32.984.9Serious Infections2.255.1ConclusionThe infection rates reported with GLM in this cohort are low compared to the rates reported in earlier registry studies with TNFi. Changes in the characteristics of patients starting TNFi (lower disease activity, shorter disease duration, less exposure to CS) in recent years may explain the decreased risk of infection. Compared to the available literature, treatment with GLM was associated with relatively low infection rate. Most infections occurred during the first 6 months of treatment and decreased thereafter. Presence of pulmonary disease, higher age, and higher CS dose were identified as significant predictors of infections. SIs, but not NSIs, were associated with significantly higher odds of treatment discontinuation-TNFi.Disclosure of InterestsLouis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Teva, Consultant of: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Teva, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Teva, Proton Rahman Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Grant/research support from: Janssen and Novartis, John Kelsall: None declared, Jane Purvis: None declared, Emmanouil Rampakakis Consultant of: Janssen, Allen Lehman Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Meagan Rachich Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Francois Nantel Shareholder of: Johnson & Johnson, Employee of: Retiree from Janssen Pharmaceutical Companies of Johnson & Johnson, Marilise Marrache Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Odalis Asin Milan Shareholder of: Johnson & Johnson, Employee of: Employees of Janssen Pharmaceutical Companies of Johnson & Johnson
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Crane EK, Brown J, Lehman A, Tait DL, Naumann RW. Perioperative Recovery and Narcotic Use in Laparoscopic versus Robotic Surgery for Endometrial Cancer. J Minim Invasive Gynecol 2021; 28:1898-1902. [PMID: 33965644 DOI: 10.1016/j.jmig.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To compare intraoperative and perioperative narcotic use, recovery room time, and total hospital stay for patients treated with robotic vs laparoscopic surgery for endometrial cancer. DESIGN Retrospective cohort. SETTING Teaching hospital. PATIENTS All patients having minimally invasive surgery in the division of gynecologic oncology during a 20-month period. INTERVENTION Laparoscopic cases were compared with robot-assisted cases with respect to perioperative outcome. MEASUREMENT AND MAIN RESULTS Hospital billing records were used to identify all patients with endometrial cancer treated from January 1, 2018 through July 31, 2019 undergoing either laparoscopic or robotic surgery. Data were collected including total narcotic use converted to intravenous morphine milligram equivalent (MME), total amount of time in recovery, and length of hospital stay. A total of 139 laparoscopic and 101 robotic surgeries were eligible for analysis. There was no difference between the groups with respect to blood loss, alcohol use, or smoking. Patients undergoing laparoscopy had a significantly lower body mass index compared with patients undergoing robotic surgery (32.9 vs 38.0 kg/m2; p <.001). Univariate analysis showed no difference between the 2 groups with respect to narcotic use in surgery (21.7 vs 21.1 MME; p = .64), recovery (4.3 vs 4.5 MME; p = .70), or total dose (26.0 vs 25.6 MME; p = .78). However, patients who underwent a robotic approach had a longer recovery room time (128 minutes vs 163 minutes; p <.001 and a longer surgical time (288 minutes vs 204 minutes; p = .001). Patients in the robotic group were also more likely to undergo full lymphadenectomy than patients in the laparoscopy group (38.0% vs 20.8% p <.001). In a multivariate analysis, the only significant factors for predicting total narcotic dose were age, use of a preoperative enhanced recovery after surgery program, and surgical time. Patients who had laparoscopy were more likely to achieve same-day discharge (39.3% vs 17.8%; p <.001), but in the multivariate analysis, the type of surgery did not predict same-day discharge. CONCLUSION There was no difference in narcotic use in the perioperative period with robotic surgery compared with laparoscopy. Recovery time was longer for robotic surgery, but this was not significant in multivariate analysis. Same-day discharges were less frequent with robotics, which may be more related to the physician's choice rather than the procedure.
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Affiliation(s)
- Erin K Crane
- Levine Cancer Institute, Atrium Health System, Charlotte, North Carolina (all authors)..
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health System, Charlotte, North Carolina (all authors)
| | - Alanna Lehman
- Levine Cancer Institute, Atrium Health System, Charlotte, North Carolina (all authors)
| | - David L Tait
- Levine Cancer Institute, Atrium Health System, Charlotte, North Carolina (all authors)
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health System, Charlotte, North Carolina (all authors)
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Tait DL, Lehman A, Brown J, Crane EK, Kemp EV, Taylor VD, Naumann RW. Comparison of Perioperative Outcomes between Minimally Invasive Sentinel Node Biopsy and Full Lymphadenectomy for Endometrial Cancer. J Minim Invasive Gynecol 2020; 28:1514-1518. [PMID: 33352316 DOI: 10.1016/j.jmig.2020.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To review the perioperative differences between patients undergoing a minimally invasive sentinel lymph node dissection and those undergoing a full lymphadenectomy. DESIGN Retrospective review. SETTING Teaching hospital. PATIENTS All patients undergoing a minimally invasive procedure for endometrial cancer that included nodal evaluation. INTERVENTIONS Patients who underwent a sentinel lymph node biopsy were compared with those who underwent a full lymphadenectomy at the time of minimally invasive surgery by either laparoscopic or robot-assisted surgery. MEASUREMENTS AND MAIN RESULTS A total of 241 minimally invasive surgery procedures for endometrial cancer were performed during the 20-month study period. Nodal dissection was indicated and performed in 156 (65%) of these patients, with 93 undergoing a sentinel lymph node biopsy and 63 a full lymphadenectomy. There was no difference between the sentinel group and the lymphadenectomy group with respect to age, estimated blood loss (p = .23), use of a preoperative enhanced recovery after surgery program (p = .82), or body mass index (34.0 kg/m2 vs 33.7 kg/m2; p = .87). The use of full lymphadenectomy was very dependent on the surgeon (p <.001). There was no difference in narcotic use in milligram intravenous equivalents of morphine in surgery (20.9 vs 22.2; p = .37), recovery (4.6 vs 4.9; p = .73), or total dose (25.4 vs 27.0; p = .33). The surgical procedure was longer with lymphadenectomy (185.2 minutes vs 214.2 minutes; p <.001) and the relative risk of discharge from recovery was lower (0.71; 95% confidence interval, 0.51-0.97; p = .03). The hospital stay was longer with lymphadenectomy (16.3 hours vs 25.5 hours; p <.001) and same-day discharge less frequent (48.5% vs 13.8%; p <.001). A multivariate analysis confirmed that sentinel node biopsy was associated with an increased relative risk of discharge of 1.68 (95% confidence interval 1.11-2.53; p = .01) CONCLUSION: Total narcotic requirements are similar between sentinel node biopsy and lymphadenectomy. However, sentinel node biopsy is associated with a shorter surgical time, recovery time, and hospital stay.
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Affiliation(s)
- David L Tait
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)..
| | - Alanna Lehman
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Erin K Crane
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Erin V Kemp
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Valerie D Taylor
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
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Lares Romero C, Davis J, Nandi U, Sukkarieth H, Spear M, Noel J, Fowler R, Lehman A. 113 Bier Block versus Sedation: A Comparison of Patient Characteristics and Emergency Department Metrics in Pediatric Forearm Reduction. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Naumann R, Lehman A, Crane E, Tait D, Higgins R, Brown J. Comparison in outcomes between minimally invasive sentinel nodes versus full laparoscopic lymphadenectomy for endometrial cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Naumann R, Lehman A, Crane E, Tait D, Higgins R, Brown J. Factors associated with same day discharge (SDD) after laparoscopic surgery in gynecologic oncology. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lehman A, Kemp EV, Brown J, Crane EK, Tait DL, Taylor VD, Naumann RW. Pre-emptive Non-narcotic Pain Medication before Minimally Invasive Surgery in Gynecologic Oncology. J Minim Invasive Gynecol 2020; 28:811-816. [PMID: 32730991 DOI: 10.1016/j.jmig.2020.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To review the impact of enhanced recovery after surgery (ERAS) after minimally invasive surgery (MIS) with respect to perioperative narcotics, time in the recovery room, and total time in hospital. DESIGN Retrospective cohort. SETTING Teaching hospital. PATIENTS All patients having MIS in the division of gynecologic oncology during a 20-month period. INTERVENTION MIS cases were compared before and after the implementation of an ERAS protocol that incorporated orally administered acetaminophen, gabapentin, and celecoxib. MEASUREMENT AND MAIN RESULTS A total of 800 MIS cases were performed during the period (77% laparoscopy, 18% robotic, 5% mini-lap). Of these, 449 cases were treated without and 351 with the ERAS protocol. There were no significant differences between the groups with respect to age, BMI, surgery type, smoking, surgical indication, blood loss, or diagnosis. Total narcotic use in milligram intravenous equivalents of morphine (mg IV Eq) was significantly less in the ERAS patients (28.5-mg IV Eq vs 23.6-mg IV Eq; p <.001). There was a trend toward less narcotics in recovery (4.8-mg IV Eq vs 4.1-mg IV Eq; p = .08). Postoperative recovery room time was not different between the groups (129 minutes vs 131 minutes; p = .66). ERAS was associated with a higher rate of same day discharge (38.5% vs 49.0%; p = .003) and a shorter length of hospital stay (22.9 hours vs 18.5 hours; p = .008), with a hazard ratio for discharge of 0.82 (0.71-0.94). However, the same day discharge rate varied widely between treating physicians (20% to 56%). CONCLUSIONS Implementation of an ERAS protocol for MIS appears to reduce total perioperative narcotic use but does not reduce recovery room time. There was a reduction in total hospital time, but this may be dependent on practice patterns of individual physicians.
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Affiliation(s)
- Alanna Lehman
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Erin V Kemp
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Erin K Crane
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - David L Tait
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - Valerie D Taylor
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors)
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina (all authors).
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Slomp C, Morris E, Inglis A, Lehman A, Austin J. Patient outcomes of genetic counseling: Assessing the impact of different approaches to family history collection. Clin Genet 2018; 93:830-836. [DOI: 10.1111/cge.13176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- C. Slomp
- Department of Psychiatry; University of British Columbia; Vancouver Canada
| | - E. Morris
- Department of Psychiatry; University of British Columbia; Vancouver Canada
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - A. Inglis
- Department of Psychiatry; University of British Columbia; Vancouver Canada
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - A. Lehman
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - J. Austin
- Department of Psychiatry; University of British Columbia; Vancouver Canada
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
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Keystone E, Baer P, Olszynski W, Baker M, Haraoui B, Bensen W, Faraawi R, Rampakakis E, Sampalis J, Lehman A, Nantel F, Osborne B, Tkaczyk C, Maslova K. FRI0172 Primary and Secondary Non-Response in RA Patients Treated with An anti-TNF: An Analysis from A Prospective, Observational Registry. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chow A, Bensen W, Arendse R, Keystone E, Baer P, Kelsall J, Olszynski W, Rodrigues J, Avina-Zubieta A, Baker M, Olszynski W, Bensen W, Baer P, Choquette D, Kapur S, Jaroszynska A, Sampalis J, Choquette D, Rampakakis E, Kapur S, Stewart J, Tkaczyk C, Sampalis J, Shawi M, Rampakakis E, Lehman A, Nantel F, Otawa S, Tkaczyk C, Lehman A. SAT0062 What is the Effect of TNF Inhibitors on Employment Status in Rheumatoid Arthritis Patients and what are the Predictors of Progression to Unemployment? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Faraawi R, Dixit S, Mulgund M, Bensen W, Kelsall J, Choquette D, Baker M, Fortin I, Sampalis J, Rampakakis E, Tkaczyk C, Lehman A, Nantel F. AB1163 Prevalence of Smoking and Impact on Disease Parameters Among Ankylosing Spondylitis, Rheumatoid Arthritis and Psoriatic Arthritis Patients Treated with Infliximab or Golimumab. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bensen W, Keystone E, Baer P, Rodrigues J, Avina-Zubieta A, Olszynski W, Choquette D, Kapur S, Sampalis J, Rampakakis E, Tkaczyk C, Shawi M, Lehman A, Nantel F, Otawa S. SAT0090 Exploring The Das: What is the Level of Agreement in the Classification of Remission and Low Disease Activity Among the Various Versions of the Disease Activity Score (DAS) and Their Correlation? An Analysis from a Prospective, Observational Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Keystone E, Baer P, Avina-Zubieta A, Jaroszynska A, Rodrigues J, Arendse R, Sholter D, Starr M, Masetto A, Sampalis J, Rampakakis E, Tkaczyk C, Shawi M, Lehman A, Nantel F, Otawa S. FRI0036 What is the Level of Agreement Between Disease Activity Indices and Response Criteria Among Rheumatoid Arthritis Patients Treated with TNF Inhibitors? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baer P, Keystone E, Bensen W, Thorne C, Haraoui B, Choquette D, Arendse R, Kelsall J, Sheriff M, Sampalis J, Rampakakis E, Tkaczyk C, Shawi M, Lehman A, Nantel F, Otawa S. AB0304 What Proportion of Patients Fail to Achieve Das, Cdai, Sdai Remission Based on Patient Global assessment? An Analysis from a Prospective, Observational Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hathaway J, Gibbs K, Bennett M, Chakrabarti S, Kerr C, Leather R, Lehman A, Sherwin E, Sanatani S, Arbour L, Krahn A. THE BC INHERITED ARRHYTHMIA PROGRAM: A MULTIDISCIPLINARY APPROACH TO FAMILIES AT RISK FOR SUDDEN DEATH. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Haraoui B, Sheriff M, Khraishi M, Starr M, Kelsall J, Baker M, Arendse R, Dixit S, Bensen W, Baer P, Faraawi R, Rampakakis E, Sampalis J, Otawa S, Lehman A, Nantel F, Shawi M. THU0241 Predictors of Acr/Eular Boolean and SDAI Remission in Patients with Established Rheumatoid Arthritis Treated with Anti-TNF: an Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rahman P, Shaikh S, Starr M, Bensen W, Choquette D, Olszynski W, Sheriff M, Zummer M, Rampakakis E, Sampalis J, Lehman A, Otawa S, Nantel F, Letourneau V, Shawi M. AB0760 Real-World Validation of the Minimal Disease Activity Index in Psoriatic Arthritis: an Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jovaisas A, Starr M, Choquette D, Zummer M, Arendse R, Sholter D, Faraawi R, Rodrigues J, Kapur S, Rampakakis E, Sampalis J, Nantel F, Lehman A, Otawa S, Shawi M. AB0302 Profile of Joint Involvement over Time in Rheumatoid Arthritis and Psoriatic Arthritis Patients Treated with Anti-TNF in A Real-World Setting. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Haraoui B, Jovaisas A, Bensen W, Faraawi R, Kelsall J, Dixit S, Rodrigues J, Sheriff M, Rampakakis E, Sampalis J, Lehman A, Otawa S, Nantel F, Shawi M. SAT0035 Impact of Corticosteroid Use on Remission Sustainability and Infection Rates among Rheumatoid Arthritis Patients in Remission While on Infliximab: Treatment Implications Based on A Real-World Population. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rahman P, Choquette D, Khraishi M, Bensen W, Shaikh S, Sholter D, Sheriff M, Rampakakis E, Sampalis J, Nantel F, Otawa S, Lehman A, Shawi M. SAT0363 Validation of the Ankylosing Spondylitis Disease Activity SCORE (ASDAS) and Effectiveness of Infliximab in the Treatment of Ankylosing Spondylitis over 4 Years. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rahman P, Choquette D, Bensen W, Khraishi M, Shaikh S, Arendse R, Fortin I, Chow A, Sholter D, Psaradellis E, Sampalis J, Otawa S, Nantel F, Lehman A, Shawi M. AB0761 Prevalence of Enthesitis and Dactylitis, Impact on Disease Severity and Evolution over 12 Months in PSA Patients Treated with Anti-TNF in A Real-World Setting. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Choquette D, Sholter D, Fortin I, Starr M, Thorne C, Baker M, Arendse R, Baer P, Zummer M, Rodrigues J, Sheriff M, Rampakakis E, Sampalis J, Nantel F, Lehman A, Otawa S, Shawi M. AB0234 Differential Relative Contribution of Individual Components on DAS28 over Time. an Analysis from the Prospective, Observational Registry, Biotrac. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Choquette D, Starr M, Khraishi M, Bensen W, Shaikh S, Rodrigues J, Sholter D, Sheriff M, Vaillancourt J, Sampalis J, Lehman A, Otawa S, Nantel F, Shawi M. SAT0336 Change over Time in the Profile of Ankylosing Spondylitis Patients Treated with Infliximab in A REAL World Routine Care. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND The identification of inborn errors of metabolism (IEM) in adults presenting with a wide range of neurological symptoms is a relatively new field in medicine. We sought to identify which treatable IEM have been diagnosed for the first time in adults and generate a protocol for metabolic screening targeting those treatable disorders. METHODS Medline/Pubmed searches of English language literature limited to the adult age group were performed. Diseases identified through this search were then compared to previously published lists of treatable IEM in both adults and children. RESULTS 85% of the treatable conditions known to cause global developmental delay or intellectual disability in children had reports where the diagnosis of that IEM was made in one or more adult patients with neurological symptoms. Screening tests in blood, urine, CSF and MRI can detect most of these treatable conditions but the diagnostic accuracy of these screening tests in adults is not clear. CONCLUSION Treatable IEM need to be considered in the differential diagnosis of neurological symptoms in patients of any age.
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Thorne C, Khraishi M, Haraoui B, Rodrigues J, Jovaisas A, Choquette D, Dixit S, Sholter D, Baer P, Sheriff M, Rampakakis E, Sampalis JS, Nantel F, Lehman A, Shawi M, Otawa S. THU0131 Correlation of Individual HAQ Questions with Outcome Measures in Rheumatoid Arthritis: Implications for Instrument Reduction. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVE This study examines 6-month follow-up data from participants in a randomized trial of a peer-driven 12-session family support and education program, called family-to-family (FTF) and offered by the US National Alliance on Mental Illness, to determine whether improvements in distress, family functioning, coping and empowerment were sustained. METHOD Individuals randomized to the FTF condition were assessed after program completion and then 3 months later on measures of distress, family functioning, coping, and empowerment. We used a multilevel regression model (sas proc mixed) to test for significant changes over time (baseline, 3 and 9 months). RESULTS All significant benefits that FTF participants gained between baseline and immediately post-FTF were sustained at 9 months including reduced anxiety, improved family problem-solving, increased positive coping, and increased knowledge. Greater class attendance was associated with larger increases in empowerment and reductions in depression and displeasure with ill relative. CONCLUSION Evidence suggests that benefits of the FTF program were sustained for at least 6 months without any additional boosters or supports. Peer-based programs may produce sustained benefits for individuals seeking help in addressing challenges and stresses related to having a family member with a mental illness.
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Affiliation(s)
- A Lucksted
- University of Maryland School of Medicine, Baltimore, MD, USA.
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Whitson B, Lehman A, Wehr A, Hayes D, Kirkby S, Pope-Harman A, Kilic A, Higgins R. To Induce or Not To Induce: A 21st Century Evaluation of Lung Transplant Immunosuppression. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Reiter PL, Wee AG, Lehman A, Paskett ED. Oral cancer screening and dental care use among women from Ohio Appalachia. Rural Remote Health 2012; 12:2184. [PMID: 23240899 PMCID: PMC3838993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Residents of Appalachia may benefit from oral cancer screening given the region's higher oral and pharyngeal cancer mortality rates. The current study examined the oral cancer screening behaviors and recent dental care (since dentists perform most screening examinations) of women from Ohio Appalachia. METHODS Women from Ohio Appalachia were surveyed for the Community Awareness Resources Education (CARE) study, which was completed in 2006. A secondary aim of the CARE baseline survey was to examine oral cancer screening and dental care use among women from this region. Outcomes included whether women (n=477; cooperation rate = 71%) had ever had an oral cancer screening examination and when their most recent dental visit had occurred. Various demographic characteristics, health behaviors and psychosocial factors were examined as potential correlates. Analyses used multivariate logistic regression. RESULTS Most women identified tobacco-related products as risk factors for oral cancer, but 43% of women did not know an early sign of oral cancer. Only 15% of women reported ever having had an oral cancer screening examination, with approximately 80% of these women indicating that a dentist had performed their most recent examination. Women were less likely to have reported a previous examination if they were from urban areas (OR=0.33, 95% CI: 0.13-0.85) or perceived a lower locus of health control (OR=0.94, 95% CI: 0.89-0.98). Women were more likely to have reported a previous examination if they had had a dental visit within the last year (OR=2.24, 95% CI: 1.03-4.88). Only 65% of women, however, indicated a dental visit within the last year. Women were more likely to have reported a recent dental visit if they were of a high socioeconomic status (OR=2.83, 95% CI: 1.58-5.06), had private health insurance (OR=2.20, 95% CI: 1.21-3.97) or had consumed alcohol in the last month (OR=2.03, 95% CI: 1.20-3.42). CONCLUSION Oral cancer screening was not common among women from Ohio Appalachia, with many missed opportunities having occurred at dental visits. Education programs targeting dentists and other healthcare providers (given dental providers are lacking in some areas of Ohio Appalachia) about opportunistic oral cancer screening may help to improve screening in Appalachia. These programs should include information about populations at high risk for oral cancer (eg smokers) and how screening may be especially beneficial for them. Future research is needed to examine the acceptability of such education programs to healthcare providers in the Appalachian region and to explore why screening was less common among women living in urban areas of Ohio Appalachia.
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Affiliation(s)
- P L Reiter
- The Ohio State University, Columbus, Ohio, USA.
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Isley M, Jensen J, Nichols M, Bednarek P, Lehman A, Edelman A. Intrauterine lidocaine infusion for pain management during outpatient transcervical tubal sterilization. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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31
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Lesinski GB, Raig ET, Zimmerer JM, Karpa V, Nuovo G, Lehman A, Peters S, Kacher JE, Magro CM, Croce CM, Carson WE. Micro-RNA-21 and micro-RNA-155 as predictors of a malignant phenotype in melanocytic lesions. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zimmerer JM, Lehman A, Ruppert A, Olencki T, Kendra K, Walker MJ, Carson WE. Interferon-alpha-2b induced signal transduction and gene regulation in patient immune cells is not enhanced by a dose increase from 5 MU/m 2 to 10 MU/m 2. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3026 Background: High dose interferon-alpha-2b (IFN-a) is employed as an adjuvant in melanoma patients who have had surgery for high-risk lesions. It mediates its anti-tumor effects via activation of the transcription factor STAT1 (signal transducer and activator of transcription) within host immune cells. We hypothesized that intermediate doses of IFN-a would be just as effective as higher doses in stimulating the activation of STAT1 and gene transcription in immune cells. Methods: Samples for analysis were obtained from patients with metastatic melanoma who were enrolled in a clinical trial of bevacizumab in combination with escalating doses of IFN-a (5 MU/m^2 and then 10 MU/m^2). Peripheral blood mononuclear cells (PBMCs) were procured before and 1 hour after the administration of IFN-a and analyzed for the presence of phosphorylated STAT1 (P-STAT1) and P-STAT2 by intracellular flow cytometric analysis and the induction of interferon stimulated gene (ISG) transcripts by Real Time PCR. Results: P-STAT1 in response to 5 MU/m^2 IFN-a was higher than that for the 10 MU/m^2 dose (p = 0.0617). The 5 MU/m^2 dose also led to a greater activation of STAT2 (p = 0.0388). The induction of interferon stimulated genes (ISGs; IFIT1, IFIT2, OAS3) within PBMCs was not enhanced following the increase in IFN-a dose to 10 MU/m^2 at 2 weeks although inhibitors of IFN-a-signaling (SOCS1 and SOCS3) were activated to a greater degree. In addition, microarray analysis was performed on 4 patients and revealed that only one of 36 interferon regulated genes was expressed to a greater extent following treatment with 10 MU/m^2 IFN-a as compared to 5 MU/m^2. Conclusions: These results suggest that 5 MU/m^2 of IFN-a are as effective as higher doses with respect to the induction of STAT signal transduction and ISGs within immune effector cells. No significant financial relationships to disclose.
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Affiliation(s)
| | - A. Lehman
- The Ohio State University, Columbus, OH
| | | | | | - K. Kendra
- The Ohio State University, Columbus, OH
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Ahearn EP, Jamison KR, Steffens DC, Cassidy F, Provenzale JM, Lehman A, Weisler RH, Carroll BJ, Krishnan KR. MRI correlates of suicide attempt history in unipolar depression. Biol Psychiatry 2001; 50:266-70. [PMID: 11522261 DOI: 10.1016/s0006-3223(01)01098-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide represents a major health problem in the United States, and prediction of suicide attempts is difficult. No structural neuroimaging studies have been done to specifically examine findings in patients who have attempted suicide. The objective of this study was to compare MRI findings in unipolar patients with and without a history of a suicide attempt. METHODS In this post hoc analysis, 20 unipolar subjects with a history of a suicide attempt were matched by age and gender to unipolar subjects without a history of an attempt. Subjects were also matched on parameters such as cardiovascular history, electroconvulsive treatment history, and history of psychosis. Subjects with a history of any neurologic condition were excluded. There were no significant differences in age of onset of depression, number of episodes of depression, and Hamilton Depression scores between the two groups. T2-weighted magnetic resonance imaging (MRI) scans were rated using the Coffey and Boyko rating scales. RESULTS Unipolar patients with a history of a suicide attempt demonstrated significantly more subcortical gray matter hyperintensities compared with patients without such a history. CONCLUSIONS Patients with abnormal MRI findings may be at higher risk for mood disorders and suicide attempts because of disruption of critical neuroanatomic pathways. Gray matter hyperintensities in the basal ganglia may be especially associated with risk for suicide attempts.
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Affiliation(s)
- E P Ahearn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham 900 Ridgefield Drive, Raleigh, North Carolina 27609, USA
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Dixon L, Lyles A, Smith C, Hoch JS, Fahey M, Postrado L, Lucksted A, Lehman A. Use and costs of ambulatory care services among Medicare enrollees with schizophrenia. Psychiatr Serv 2001; 52:786-92. [PMID: 11376226 DOI: 10.1176/appi.ps.52.6.786] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to identify predictors of the use and cost of ambulatory care services among Medicare recipients with schizophrenia. METHODS The design was a cross-sectional analysis of Medicare claims in 1991. The study subjects were a 5 percent random sample of all persons in the United States who had at least one Medicare service claim in 1991 and who were diagnosed as having schizophrenia in any care setting. Outcome measures included use and cost of any ambulatory care service, individual therapy, psychiatric somatotherapy, group therapy, or family therapy. RESULTS For nearly 25 percent of the total sample of 12,440, no claims were filed for ambulatory care services in 1991. The mean+/-SD number of ambulatory care visits during the year was 7.9+/-21. The most frequently used type of therapy was individual therapy (5+/-14 visits). The mean+/-SD yearly cost of care for persons who received ambulatory care services was $470+/-$1,028. Among persons under 65 years of age, Caucasians were about 1.5 times as likely as African Americans to have received an ambulatory care service and 1.3 times as likely to have received individual therapy. Persons who were 65 or older were less likely to have received any service. Among service recipients, costs of care were lower for African Americans and for older people. CONCLUSIONS The use of Medicare-funded ambulatory care services by persons with schizophrenia varied by race and age. Further investigation is required to determine whether subgroups of individuals who do not have additional insurance coverage or access to services are receiving substandard care.
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Affiliation(s)
- L Dixon
- Center for Mental Health Services Research, University of Maryland School of Medicine, Baltimore, USA.
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Abstract
People with schizophrenia may be at increased risk for Type II diabetes because of the side effects of antipsychotic medication, poorer overall physical health, less healthy lifestyles, and poorer health care. The present study uses data bases collected by the Schizophrenia Patient Outcomes Research Team (PORT) to assess the prevalence and demographic and clinical correlates of diabetes within large populations of persons receiving treatment for schizophrenia. In the Schizophrenia PORT, Medicaid and Medicare data from 1991 and more recent interview data were collected regarding the comorbidity of schizophrenia and diabetes: prevalence, quality of life, physical health, and services utilization and costs. The study found that rates of diagnosed diabetes exceeded general population statistics well before the widespread use of the new antipsychotic drugs. Risk factors for diabetes were similar to those observed in the general population. The linkage of diabetes to poor physical health, medical morbidity, and increased service use and cost requires attention. This study of diabetes in the early 1990s suggests that even before the widespread use of the atypical antipsychotic drugs, diabetes was a major problem for persons with schizophrenia.
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Affiliation(s)
- L Dixon
- Department of Psychiatry, University of Maryland, Baltimore 21201, USA.
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Abstract
This study evaluated the relationships between self-ratings of physical role functioning and general health, two components of the MOS SF-36, and a variety of demographic, quality of life, clinical, functional, and attitudinal variables in a cohort of adults living with severe and persistent mental illness (SPMI). We hypothesized that poorer self-perceptions of physical functioning and general health would be significantly related to more severe symptoms and poorer functioning and quality of life. Study subjects were 218 adults with SPMI enrolled in a randomized controlled trial comparing two vocational interventions for persons who were unemployed. Hierarchical regression analysis was used to determine whether psychiatric symptoms, poorer self-perceptions of role limitations due to physical health problems and overall general health independently contributed to more severe symptoms and poorer functioning and quality of life. Psychiatric symptoms were inversely related to size of social network and satisfaction with safety. Increased role limitations were associated with reduced medication compliance, general life satisfaction, and satisfaction with health, daily activities, and safety. Reduced general health was significantly associated with reduced work motivation, self-esteem, current inability to work, self-report of functioning, and almost all subjective life satisfaction domains. Within this group of people with severe mental illness, psychiatric symptoms were minimally associated with outcomes. Physical role limitations contributed more, and an integrated global measure of overall health perception was most important. If we are to help persons with severe mental illness maximize their quality of life and functioning, our clinical interventions should employ an approach that appreciates and recognizes the importance of the patients' experience of a holistic and integrated experience of health.
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Affiliation(s)
- L Dixon
- University of Maryland, Center for Mental Health Services Research, Baltimore 21201, USA
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37
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Goldberg RW, Lucksted A, McNary S, Gold JM, Dixon L, Lehman A. Correlates of long-term unemployment among inner-city adults with serious and persistent mental illness. Psychiatr Serv 2001; 52:101-3. [PMID: 11141538 DOI: 10.1176/appi.ps.52.1.101] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study identified demographic, clinical, and vocational rehabilitation-related correlates of long-term unemployment among 219 adults with severe mental illness. Fifty-one percent of the sample had been unemployed five or more years before enrollment. Older age, a diagnosis of psychosis, severity of negative symptoms, and more previous hospitalizations were all significantly related to long-term unemployment. Gender, race, education, substance disorder diagnosis, severity of negative symptoms, and vocational training experience were not. The findings underscore the relevance of clinical and neurocognitive impairments to long-term unemployment and point to the need to critically reevaluate the effectiveness of traditional vocational rehabilitation services.
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Affiliation(s)
- R W Goldberg
- Department of Psychiatry, University of Maryland, Baltimore 21201, USA.
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Lancon C, Auquier P, Launois R, Toumi M, Llorca PM, Bebbington P, Lehman A. [Evaluation of the quality of life of schizophrenic patients: validation of the brief version of the Quality of Life Interview]. Encephale 2000; 26:11-6. [PMID: 11064834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
UNLABELLED The main objective of the study was to determine the psychometric properties (mainly, validity and reliability) of the French language version of the brief Quality of Life Interview (QoLI). That instrument evaluates both the subjective and objective aspects of quality of life. METHODS 128 patients fulfilling the DSM IV criteria for schizophrenia were included. Quality of life was evaluated using the brief QoLI. Schizophrenic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). The validity of the internal structure of the QoLI was investigated by means of item analysis, study of the correlations between the items and between the item-dimensions and principal component analysis addressing the subjective fields. The validity of the external structure was mainly investigated through the nomological validity study. The reliability of the scale was evaluated by studying the internal consistency. In addition, the acceptability of the scale was documented. RESULTS The results of the study of the validity of the internal structure confirmed the pertinence of the pre-defined fields, particularly the subjective fields. Only some of the subjective fields of the QoLI showed significant correlations with the PANSS sub-scales. The acceptability of the scale was satisfactory. CONCLUSIONS The psychometric properties of the French language version of the brief QoLI appeared satisfactory. The brief QoLi was shown to be an easily used instrument for assessment of the various objective and subjective aspects of the quality of life of schizophrenic patients.
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Affiliation(s)
- C Lancon
- SHU de Psychiatrie d'Adultes, CHU Sainte-Marguerite, Marseille
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Rosenheck RA, Desai R, Steinwachs D, Lehman A. Benchmarking treatment of schizophrenia: a comparison of service delivery by the national government and by state and local providers. J Nerv Ment Dis 2000; 188:209-16. [PMID: 10789997 DOI: 10.1097/00005053-200004000-00003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compared treatment of schizophrenia in two types of organization: a national, government-operated health care system, the Department of Veterans Affairs (VA), and in hospitals and clinics operated by state and local providers. Between 1994 and 1996, 746 male patients with a clinical diagnosis of schizophrenia residing in two states in the Southeast and Midwest were surveyed: 192 VA inpatients were compared with 96 non-VA inpatients, and 274 VA outpatients were compared with 184 non-VA outpatients. VA patients were older and had higher incomes than non-VA patients but did not differ significantly on measures of clinical status, satisfaction with providers, or community adjustment. VA outpatients were more likely to have been hospitalized during the previous year than non-VA outpatients and were less likely to have received services from a day hospital, from a case manager or social worker, or to have received crisis intervention services. On 5 of 26 Schizophrenic Patient Outcomes Research Team treatment recommendations, a smaller proportion of VA than non-VA patients adhered to standards. Four of these reflected reduced access among VA patients to psychosocial services such as work therapy, job training, or case management services. Cross-sectional surveys can be used to compare quality of care across service systems. VA care was associated with similar satisfaction and clinical outcomes but greater reliance on hospital treatment and less use of community-based psychosocial services.
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Affiliation(s)
- R A Rosenheck
- VA Connecticut-Massachusetts Mental Illness Research Education and Clinical Center, VA Northeast Program Evaluation Center, West Haven, CT 06516-2770, USA
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Abstract
This study determined the prevalence of medical comorbidities in a cohort of persons receiving treatment for schizophrenia and the association of medical comorbidity with physical and mental health status. A total of 719 persons with schizophrenia sampled from a variety of community and treatment settings as part of the schizophrenia Patient Outcomes Research Team (PORT) participated in a survey interview. Multiple regression analyses were used to assess sociodemographic factors associated with the number of current medical comorbidities and the association of medical comorbidity count with patient ratings of physical health, mental health, symptoms, and quality of life. The majority of patients reported at least one medical problem. Problems with eyesight, teeth, and high blood pressure were most common. A greater number of current medical problems independently contributed to worse perceived physical health status, more severe psychosis and depression, and greater likelihood of a history of a suicide attempt. This study underscores the need to attend to somatic health care for persons with schizophrenia as well as the linkage of physical and mental health status.
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Affiliation(s)
- L Dixon
- University of Maryland, Department of Psychiatry, Baltimore 21201, USA
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Abstract
The precise biochemical mechanism underlying the synergistic action of gene activators on eukaryotic transcription has eluded a solution, largely because of the technical difficulties inherent in analyzing the mechanics of a 2.5 MDa complex comprising greater than 50 polypeptide components. To complement the biochemical approach we have employed mathematical modeling as a means to understand the mechanism of synergy. Parameters relevant to activated transcription were varied in a simple biochemical system and the data were compared to the transcriptional response predicted by a multi-component statistical model. We found that the model achieved a consistent, semi-quantitative description of the measured transcriptional response, and enabled the characterization and measurement of thermodynamic parameters in the in vitro system. The results provide evidence for the existence of cooperativity in the activation process beyond what would be predicted from one current model suggesting that activators function solely by simple recruitment of the general transcription machinery to the promoter.
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Affiliation(s)
- J Wang
- School of Medicine, University of California, Los Angeles, CA, Box 1737, USA
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Dixon L, Lyles A, Scott J, Lehman A, Postrado L, Goldman H, McGlynn E. Services to families of adults with schizophrenia: from treatment recommendations to dissemination. Psychiatr Serv 1999; 50:233-8. [PMID: 10030482 DOI: 10.1176/ps.50.2.233] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Data from the Schizophrenia Patient Outcomes Research Team project were examined to determine the extent to which families of adults with schizophrenia receive services and whether training staff in the provision of family services increases service availability. METHODS For patients with a diagnosis of schizophrenia, paid claims for family therapy were identified in 1991 in a nationally representative sample of Medicare data and one state's Medicaid data. In a field study in two states, 530 patients were asked about services received by their families. A quasiexperimental dissemination of a family intervention was done at nine agencies; staff at four agencies received a standard didactic presentation, and staff at five received that standard presentation paired with intensive training. RESULTS In the representative national Medicare sample of 15,425 persons with schizophrenia, .7 percent (N=108) had an outpatient claim for family therapy. This figure was 7.1 percent in the Medicaid sample of 5,393 persons with schizophrenia in one state. Of the 530 patients in the field study who reported having contact with their families, 159 (30 percent) reported that their families had received information, advice, or support about their illness, and 40 (8 percent) responded that their families had attended an educational or support program. At the four agencies where staff received only didactic training, no changes in family services were found after one year. Three of the five agencies where staff participated in intensive training enhanced their family services. CONCLUSIONS A minority of families of persons with schizophrenia receive information about the illness from providers. Implementation of model family interventions is possible with considerable technical assistance. A gap exists between best practices and standard practices for families of persons with schizophrenia.
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Affiliation(s)
- L Dixon
- Center for Mental Health Services, Department of Psychiatry, University of Maryland School of Medicine, Baltimore 21201, USA.
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Ankersmit J, Schuster M, Shah S, Olson K, Lehman A, McCue J, Kocher A, Lietz K, Modak S, Edwards N, Oz M, Itescu S. T cell apoptosis and defects in cellular immunity induced by exposure to biomaterials: Implications for left ventricular assist device (LVAD) implantation. J Heart Lung Transplant 1999. [DOI: 10.1016/s1053-2498(99)80093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hong WW, Rak IW, Ciuryla VT, Wilson AM, Kylstra JW, Meltzer HY, Carpenter WT, Lehman A, Arvanitis LA. Medical-claims databases in the design of a health-outcomes comparison of quetiapine ('Seroquel') and usual-care antipsychotic medication. Schizophr Res 1998; 32:51-8. [PMID: 9690334 DOI: 10.1016/s0920-9964(98)00040-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Treating schizophrenia is expensive. Preventing rehospitalization of patients with schizophrenia provides an attractive opportunity for cost savings, especially for patients with 'revolving-door' or multiple-episode schizophrenia. Reducing the occurrence of extrapyramidal symptoms and other adverse events associated with standard antipsychotic agents may increase compliance and reduce the rate of rehospitalization of patients with schizophrenia. Quetiapine ('Seroquel', ICI 204,636, Zeneca Pharmaceuticals) is a new dibenzothiazepine antipsychotic agent with a low propensity for extrapyramidal symptoms. We describe here a unique methodology to compare quetiapine with usual-care medications in real-world treatment settings. The trial objective is to determine if therapy with this new atypical antipsychotic agent can reduce the rate of rehospitalization and, therefore, treatment costs. Using two secondary medical-claims databases, we defined the minimal threshold for revolving-door status as 1.0 admission per year; this definition allows our trial to focus on the subpopulation of schizophrenic patients with the greatest potential for cost savings by either the new atypical antipsychotic quetiapine or usual-care therapy. We describe here the approach used in our trial.
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Affiliation(s)
- W W Hong
- Zeneca Pharmaceuticals, Wilmington, DE 19850-5437, USA
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Dixon L, Stewart B, Krauss N, Robbins J, Hackman A, Lehman A. The participation of families of homeless persons with severe mental illness in an outreach intervention. Community Ment Health J 1998; 34:251-9. [PMID: 9607162 DOI: 10.1023/a:1018713707283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study describes how an Assertive Community Treatment (ACT) team which employs a family outreach worker (FOW) interacts with homeless persons with severe mental illness and their families. METHODS The team's ratings of the frequency and importance of clients' and treatment team's family contact are summarized and compared with independent research reports on patients' satisfaction with family relations, housing and hospitalization outcomes. RESULTS 73% of clients had contact with their families. ACT worked with families of 61% of clients. ACT had less contact with the families of men (p < .01) and substance abusers (p < .01). Client days in stable housing were associated with increased ACT family contact (p < .05). CONCLUSIONS Most ACT clients had significant family contact. ACT established contact with most families, and the work with families appeared to be associated with higher levels of satisfaction with family relations and housing. The role of the FOW should be explored further.
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Affiliation(s)
- L Dixon
- University of Maryland, Department of Psychiatry, Baltimore 21201, USA
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Abstract
The last decade has witnessed the increasing importance of consumers as providers of mental health services. Assertive Community Treatment (ACT) teams and ACT variants, with their emphasis on rehabilitation and support in the client's natural environment, have hosted consumer-professional collaborations. The authors discuss one such program in which an ACT program for homeless mentally ill adults employed consumer advocates (CAs). Consumer advocates were found to have a service profile similar to other staff. Further, there is suggestive evidence that the employment of CAs created a more positive attitude toward persons with mental illness. Issues of role definition, boundaries, support with supervision and the importance of CAs' experiences with mental illness are discussed.
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Affiliation(s)
- L Dixon
- Department of Psychiatry, University of Maryland, Baltimore 21201, USA
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Abstract
OBJECTIVE Service utilization and outcomes of dually diagnosed patients with independent mental disorders and those with substance-induced mental disorders were compared. METHOD Diagnosis, service use, and severity of substance use problems at baseline and 1 year later were assessed in consecutively admitted inpatients with independent mental disorders plus substance use disorders (N = 71), substance-induced mental disorders plus substance use disorders (N = 38), and independent mental disorders only (N = 59). RESULTS At follow-up, patients with substance-induced mental disorders at baseline were more likely to have been rehospitalized than the other groups, were more likely to have used outpatient substance abuse services, were less likely to have an independent mental disorder, and had the most severe alcohol- and drug-related impairment. CONCLUSIONS Treatment programs for both types of dual diagnosis patients must address mental health concerns.
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Affiliation(s)
- L Dixon
- Department of Psychiatry, University of Maryland, Baltimore 21201, USA.
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Abstract
OBJECTIVE This study describes medication compliance rates among a group of homeless mentally ill subjects who received assertive community treatment. METHOD The medication compliance of 77 homeless persons who had been referred to an assertive community treatment program was prospectively evaluated at baseline and quarterly for 1 year. RESULTS A minority of the cohort (29%) was compliant at entry into the assertive community treatment program. Compliance significantly increased after 3 months (57%) and remained high through the year. Medication compliance was associated with fewer psychiatric symptoms but not with better housing placements or fewer days in the hospital. CONCLUSIONS Medication compliance rates among a cohort of homeless persons with severe mental illness were markedly higher after they entered a program of assertive community treatment.
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Affiliation(s)
- L Dixon
- Department of Psychiatry, University of Maryland at Baltimore 21201, USA.
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Abstract
Bending in plant tissues results from differential cell elongation. We have characterized Arabidopsis "hookless" mutants that are defective in differential growth in the hypocotyl. HOOKLESS1 was cloned and its predicted protein shows similarity to a diverse group of N-acetyltransferases. HOOKLESS1 mRNA is increased by treatment with ethylene and decreased in the ethylene-insensitive mutant ein2. High level expression of HOOKLESS1 mRNA results in constitutive hook curvature. The morphology of the hookless hypocotyl is phenocopied by inhibitors of auxin transport or by high levels of endogenous or exogenous auxin. Spatial patterns of expression of two immediate early auxin-responsive genes are altered in hookless1 mutants, suggesting that the ethylene response gene HOOKLESS1 controls differential cell growth by regulating auxin activity.
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Affiliation(s)
- A Lehman
- Department of Biology, University of Pennsylvania, Philadelphia, USA
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Abstract
We studied the effects of a fixed dose of fluoxetine (20 mg) or cognitive psychotherapy in a 16 week trial of patients with dysthymic disorder. More patients assigned to fluoxetine dropped out of the 16 week treatment (33%) than those assigned to cognitive therapy (9%), but this difference did not attain statistical significance. Both treatments showed improvement over baseline conditions at 8 weeks and further improvement at 16 weeks. There were no statistically significant group differences in treatment response. No follow-up data were collected so the enduring effects of the treatments are unknown. An optimal treatment for dysthymic disorder may be combined psychotherapy and pharmacotherapy for a longer period of time.
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Affiliation(s)
- D L Dunner
- Outpatient Psychiatry Center, Seattle, WA 98105-6099, USA
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