National Network of Depression Centers' Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy

ABSTRACT

Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.

Influences for Gender Disparity in Academic Neuroradiology

BACKGROUND AND PURPOSE

There has been extensive interest in promoting gender equality within radiology, a predominately male field. In this study, our aim was to quantify gender representation in neuroradiology faculty rankings and determine any related factors that may contribute to any such disparity.

MATERIALS AND METHODS

We evaluated the academic and administrative faculty members of neuroradiology divisions for all on-line listed programs in the US and Canada. After excluding programs that did not fulfill our selection criteria, we generated a short list of 85 US and 8 Canadian programs. We found 465 faculty members who met the inclusion criteria for our study. We used Elsevier's SCOPUS for gathering the data pertaining to the publications, H-index, citations, and tenure of the productivity of each faculty member.

RESULTS

Gender disparity was insignificant when analyzing academic ranks. There are more men working in neuroimaging relative to women (χ² = 0.46; P = .79). However, gender disparity was highly significant for leadership positions in neuroradiology (χ² = 6.76; P = .009). The median H-index was higher among male faculty members (17.5) versus female faculty members (9). Female faculty members have odds of 0.84 compared with male faculty members of having a higher H-index, adjusting for publications, citations, academic ranks, leadership ranks, and interaction between gender and publications and gender and citations (9).

CONCLUSIONS

Neuroradiology faculty members follow the same male predominance seen in many other specialties of medicine. In this study, issues such as mentoring, role models, opportunities to engage in leadership/research activities, funding opportunities, and mindfulness regarding research productivity are explored.

Tinea unguium in Lahore, Pakistan

During a period of 1 year, out of 202 clinically suspected cases of tinea unguium, 53 (26%) were confirmed by mycological cultures for dermatophytes. Trichophyton rubrum was the most common fungus isolated in 46 (87%) patients, followed by T. violaceum in four (7%), T. interdigitale in two (4%) and Epidermophyton floccosum in one (2%). The disease was more common in adult males and fingernails were found to be affected more often than toenails. The distal and lateral variety was seen in 41 (77%) patients, total secondary dystrophic type in 11 (21%) and proximal subungual type in one (2%). Clinical diagnosis alone is not reliable and mycological confirmation is mandatory for this potentially curable disease.

Psoralen-ultraviolet A therapy vs. psoralen-ultraviolet B therapy in the treatment of plaque-type psoriasis: our experience with fitzpatrick skin type IV

BACKGROUND

Oral psoralen, when combined with UVB, shows an increased response in psoriasis. In this study, conventional psoralen-UVA (PUVA) therapy was compared with psoralen-UVB (PUVB) therapy in plaque-type psoriasis in patients with Fitzpatrick skin type IV.

PATIENTS AND METHODS

Equal numbers of patients with stable, plaque-type psoriasis were treated with either PUVA (n = 22) or PUVB (n = 22), three times weekly until 90% clearance was achieved. A final evaluation was made 3 months later.

RESULTS

The two groups showed no significant differences in terms of clearance of disease, mean number of exposures, or the average duration of therapy; however, the cumulative dose of UVB required for clearance was significantly lower than that of UVA. Both groups had a similar acute side-effects' profile.

CONCLUSIONS

PUVB therapy is as effective as conventional PUVA in the treatment of stable, plaque-type psoriasis in patients with Fitzpatrick skin type IV. A significantly lower dose of UVB is required for clearance as compared with UVA.

Onychomycosis in Lahore, Pakistan

BACKGROUND

Onychomycosis, a common nail disorder, is caused by yeasts, dermatophytes, and nondermatophyte molds. These fungi give rise to diverse clinical presentations. The present study aimed to isolate the causative pathogens and to determine the various clinical patterns of onychomycosis in the population in Lahore, Pakistan.

PATIENTS

In 100 clinically suspected cases, the diagnosis was confirmed by mycologic culture. Different clinical patterns were noted and correlated with causative pathogens.

RESULTS

Seventy-two women (mean age, 32.6 +/- 14.8 years) and 28 men (mean age, 40.6 +/- 15.8 years) were studied. Fingernails were involved in 50%, toenails in 23%, and both fingernails and toenails in 27% of patients. The various clinical types noted were distolateral subungual onychomycosis (47%), candidal onychomycosis (36%), total dystrophic onychomycosis (12%), superficial white onychomycosis (3%), and proximal subungual onychomycosis (2%). Candida was the most common pathogen (46%), followed by dermatophytes (43%) (Trichophyton rubrum (31%), T. violaceum (5%), T. mentagrophytes (4%), T. tonsurans (2%), and Epidermophyton floccosum (1%) and nondermatophyte molds (11%) (Fusarium (4%), Scopulariopsis brevicaulis (2%), Aspergillus (2%), Acremonium (1%), Scytalidium dimidiatum (1%), and Alternaria (1%).

CONCLUSIONS

Onychomycosis is more common in women of 20-40 years of age. Distolateral subungual onychomycosis and candidal onychomycosis are the most common clinical presentations, and Candida and T. rubrum are the major pathogens in Pakistan.

A clinico-etiologic correlation in tinea capitis

BACKGROUND

Tinea capitis is a dermatophytosis with diverse clinical manifestations. The causative fungi of tinea capitis vary with geography and time. This study aimed to identify the etiologic agents and to determine the clinico-etiologic correlation of tinea capitis in Lahore, Pakistan.

METHODS

From clinically suspected cases of tinea capitis, skin scrapings and hair samples were taken and subjected to microscopy and culture.

RESULTS

Of 100 evaluable patients, 95% were children below 12 years of age with almost equal sex incidence. Noninflammatory and inflammatory lesions were seen in 56.4% and 43.6%, respectively. Trichophyton violaceum was the most common etiologic agent, responsible for 82% of infection, followed by T. tonsurans (8%), T. verrucosum (5%), and T. mentagrophytes (5%).

CONCLUSIONS

T. violaceum is the predominant pathogen causing tinea capitis in this part of the world, and gives rise to a varied clinical picture.