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Goger P, Zerr AA, Weersing VR, Dickerson JF, Crawford PM, Sterling SA, Waitzfelder B, Daida YG, Ahmedani BK, Penfold RB, Lynch FL. Health Service Utilization Among Children and Adolescents with Posttraumatic Stress Disorder: A Case-Control Study. J Dev Behav Pediatr 2022; 43:283-290. [PMID: 34817448 PMCID: PMC9124718 DOI: 10.1097/dbp.0000000000001041] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trauma exposure is widely prevalent, with more than 60% of adolescents having experienced at least 1 traumatic event and a third of those at high risk to develop posttraumatic stress disorder (PTSD). Data are scarce and out of date on the services children and adolescents with PTSD receive, impeding efforts to improve care and outcomes. This study examines health service use for a large and diverse sample of children and adolescents with and without a diagnosis of PTSD. METHOD Using a matched case-control study, we gathered information from 4 large health care systems participating in the Mental Health Research Network. Data from each site's electronic medical records on diagnoses, health care encounters, and demographics were analyzed. Nine hundred fifty-five 4- to 18-year-olds with a diagnosis of PTSD were identified and matched on a 1:5 ratio to 4770 controls. We compared cases with controls on frequency of service use in outpatient primary care, medical specialty care, acute care, and mental health care. We also assessed psychotropic medication use. RESULTS Children and adolescents diagnosed with PTSD used nearly all physical and mental health service categories at a higher rate than controls. However, one-third of children and adolescents did not receive even 1 outpatient mental health visit (36.86%) during the year-long sampling window. CONCLUSION Our findings suggest that children and adolescents diagnosed with PTSD may have unmet mental health needs. They are high utilizers of health services overall, but lower utilizers of the sectors that may be most helpful in resolving their symptoms.
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Affiliation(s)
- Pauline Goger
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Argero A. Zerr
- California State University Channel Islands, Camarillo, CA
| | - V. Robin Weersing
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | | | | | - Beth Waitzfelder
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Yihe G. Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Brian K. Ahmedani
- Center for Health Services Research, Henry Ford Health System, Detroit, MI
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Fortmann SP, Bailey SR, Brooks NB, Hitsman B, Rittner SS, Gillespie SE, Hill CN, Leo MC, Crawford PM, Hu W, King DS, O'Cleirigh C, Puro J, Ann McBurnie M. Trends in smoking documentation rates in safety net clinics. Health Serv Res 2020; 55:170-177. [PMID: 31930738 DOI: 10.1111/1475-6773.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the impact of provider incentive policy on smoking status documentation. DATA SOURCES Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). STUDY DESIGN This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. DATA EXTRACTION METHODS We extracted structured EMR data for patients age 18 and older with at least one primary care visit. PRINCIPAL FINDINGS Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. CONCLUSIONS Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.
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Affiliation(s)
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Neon B Brooks
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Weiming Hu
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Conall O'Cleirigh
- The Fenway Institute, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jon Puro
- Research Informatics and Analytics, OCHIN, Inc., Portland, Oregon
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Becerra TA, Massolo ML, Yau VM, Owen-Smith AA, Lynch FL, Crawford PM, Pearson KA, Pomichowski ME, Quinn VP, Yoshida CK, Croen LA. A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments. Perm J 2018; 21:16-009. [PMID: 28488981 DOI: 10.7812/tpp/16-009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. OBJECTIVE This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. METHODS Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ2 statistics for differences between responders and nonresponders. RESULTS The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% < 10 years), and ASD diagnosis (64% autistic disorder). The most frequently used services and treatments were Individualized Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. CONCLUSION These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.
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Affiliation(s)
- Tracy A Becerra
- Postdoctoral Research Fellow at the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Maria L Massolo
- Senior Research Project Manager for the Division of Research in Oakland, CA.
| | - Vincent M Yau
- Former Staff Scientist for the Autism Research Program at the Division of Research in Oakland, CA.
| | - Ashli A Owen-Smith
- Behavioral Scientist and Assistant Professor in Health Management and Policy at Georgia State University in Atlanta.
| | - Frances L Lynch
- Health Economist and Senior Investigator at the Center for Health Research in Portland, OR.
| | | | - Kathryn A Pearson
- Former Research Project Manager at the Center for Health Research in Portland, OR.
| | - Magdalena E Pomichowski
- Former Research Associate at the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Virginia P Quinn
- Former Research Scientist II in the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | | | - Lisa A Croen
- Senior Research Scientist at the Division of Research in Oakland, CA.
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Mayer KH, Loo S, Crawford PM, Crane HM, Leo M, DenOuden P, Houlberg M, Schmidt M, Quach T, Ruhs S, Vandermeer M, Grasso C, McBurnie MA. Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers. Public Health Rep 2017; 133:109-118. [PMID: 29262289 DOI: 10.1177/0033354917748670] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As the life expectancy of people infected with human immunodeficiency virus (HIV) infection has increased, the spectrum of illness has evolved. We evaluated whether people living with HIV accessing primary care in US community health centers had higher morbidity compared with HIV-uninfected patients receiving care at the same sites. METHODS We compared data from electronic health records for 12 837 HIV-infected and 227 012 HIV-uninfected patients to evaluate the relative prevalence of diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, and malignancies by HIV serostatus. We used multivariable logistic regression to evaluate differences. Participants were patients aged ≥18 who were followed for ≥3 years (from January 2006 to December 2016) in 1 of 17 community health centers belonging to the Community Health Applied Research Network. RESULTS Nearly two-thirds of HIV-infected and HIV-uninfected patients lived in poverty. Compared with HIV-uninfected patients, HIV-infected patients were significantly more likely to be diagnosed and/or treated for diabetes (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.22-1.41), hypertension (OR = 1.38; 95% CI, 1.31-1.46), dyslipidemia (OR = 2.30; 95% CI, 2.17-2.43), chronic kidney disease (OR = 4.75; 95% CI, 4.23-5.34), lymphomas (OR = 4.02; 95% CI, 2.86-5.67), cancers related to human papillomavirus (OR = 5.05; 95% CI, 3.77-6.78), or other cancers (OR = 1.25; 95% CI, 1.10-1.42). The prevalence of stroke was higher among HIV-infected patients (OR = 1.32; 95% CI, 1.06-1.63) than among HIV-uninfected patients, but the prevalence of myocardial infarction or coronary artery disease did not differ between the 2 groups. CONCLUSIONS As HIV-infected patients live longer, the increasing burden of noncommunicable diseases may complicate their clinical management, requiring primary care providers to be trained in chronic disease management for this population.
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Affiliation(s)
- Kenneth H Mayer
- 1 The Fenway Institute, Fenway Health, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 HIV Prevention Research, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Stephanie Loo
- 1 The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Michael Leo
- 4 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Paul DenOuden
- 6 Multnomah County Community Health Center, Portland, OR, USA
| | - Magda Houlberg
- 7 Howard Brown Community Health Center, Chicago, IL, USA
| | - Mark Schmidt
- 4 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Thu Quach
- 8 Asian Health Services, Oakland, CA, USA
| | | | | | - Chris Grasso
- 1 The Fenway Institute, Fenway Health, Boston, MA, USA
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Akhabue E, Rittner SS, Carroll JE, Crawford PM, Dant L, Laws R, Leo MC, Puro J, Persell SD. Implications of American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus Among Several US Networks of Community Health Centers. J Am Heart Assoc 2017; 6:JAHA.117.005627. [PMID: 28673901 PMCID: PMC5586289 DOI: 10.1161/jaha.117.005627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Little is known about statin underutilization among diabetes mellitus patients cared for in community health centers, which tend to serve socioeconomically disadvantaged populations. Implications of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear. Methods and Results We included 32 440 adults (45% male, 63% nonwhite, 29% uninsured/Medicaid) aged 40 to 75 years with diabetes mellitus who received care within 16 community health center groups in 11 states in the Community Health Applied Research Network during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel 2001 and ACC/AHA 2013 guidelines. More patients’ treatments were concordant with the ACC/AHA (52.8%) versus the National Cholesterol Education Program Adult Treatment Panel (36.2%) guideline. Female sex was associated with lower concordance for both (odds ratio [OR] 0.90, CI 0.85‐0.94; and OR 0.84, CI 0.80‐0.88, respectively). Being insured, an Asian/Pacific Islander, or primarily Spanish speaking were associated with greater concordance for both guidelines: 35.5% (11 526/32 440) were concordant with neither guideline, the majority (79.7%) having no statin prescribed; 28.2% (9168/32 440) were concordant with ACC/AHA but not the National Cholesterol Education Program Adult Treatment Panel. 8.7% of these patients had a low‐density lipoprotein cholesterol >160 mg/dL despite having a moderate‐ or high‐intensity statin prescribed. And 11.6% (3772/32 440) were concordant with the National Cholesterol Education Program Adult Treatment Panel but not with ACC/AHA. Most of these patients had a low‐density lipoprotein cholesterol between 70 and 99 mg/dL with no or a low‐intensity statin prescribed. Conclusions Opportunities exist to improve cholesterol management in diabetes mellitus patients in community health centers. Addressing care gaps could improve cardiovascular disease prevention in this high‐risk population.
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Affiliation(s)
- Ehimare Akhabue
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Reesa Laws
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Center for Primary Care Innovation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Affiliation(s)
- Christine Stewart
- Dr. Stewart and Dr. Simon are with Group Health Research Institute, Seattle. Mr. Crawford is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon. Send correspondence to Dr. Simon (e-mail: ). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Phillip M Crawford
- Dr. Stewart and Dr. Simon are with Group Health Research Institute, Seattle. Mr. Crawford is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon. Send correspondence to Dr. Simon (e-mail: ). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Gregory E Simon
- Dr. Stewart and Dr. Simon are with Group Health Research Institute, Seattle. Mr. Crawford is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon. Send correspondence to Dr. Simon (e-mail: ). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
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Cummings JR, Lynch FL, Rust KC, Coleman KJ, Madden JM, Owen-Smith AA, Yau VM, Qian Y, Pearson KA, Crawford PM, Massolo ML, Quinn VP, Croen LA. Health Services Utilization Among Children With and Without Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:910-20. [PMID: 26547921 DOI: 10.1007/s10803-015-2634-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Using data from multiple health systems (2009-2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)-including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic characteristics, comorbid physical health, and mental health conditions. Results indicated that youth with an ASD had greater health care use in many categories, but were less likely to receive important preventive services including flu shots and other vaccinations. An improved understanding of the overall patterns of health care use among this population could enable health systems to facilitate the receipt of appropriate and effective health care.
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Affiliation(s)
- Janet R Cummings
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Suite 650, Atlanta, GA, 30322, USA.
| | - Frances L Lynch
- The Center for Health Research/Northwest, Kaiser Permanente Northwest (KPNW), Portland, OR, USA
| | - Kristal C Rust
- The Center for Health Research/Northwest, Kaiser Permanente Northwest (KPNW), Portland, OR, USA
| | - Karen J Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California (KPSC), Pasadena, CA, USA
| | - Jeanne M Madden
- School of Pharmacy, Northeastern University, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (HPHCI), Boston, MA, USA
| | - Ashli A Owen-Smith
- Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia (KPGA), Atlanta, GA, USA
| | - Vincent M Yau
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
- McKesson Corporation, San Francisco, CA, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
| | - Kathryn A Pearson
- The Center for Health Research/Northwest, Kaiser Permanente Northwest (KPNW), Portland, OR, USA
| | - Phillip M Crawford
- The Center for Health Research/Northwest, Kaiser Permanente Northwest (KPNW), Portland, OR, USA
| | - Maria L Massolo
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
| | - Virginia P Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California (KPSC), Pasadena, CA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
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Lynch FL, Croen LA, Owen-Smith A, Davis RL, Hanson GC, Crawford PM, Ruse KC, Qian YX. Early Identification of Autism Spectrum Disorders Using Patterns of Service Use Prior to Diagnosis. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1375] [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] Open
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Schmidt MA, Varga AM, Crawford PM, Sengupta S, Gillespie SE, Donald JL, McBurnie MA. Capturing Sex Partner Information in the Electronic Health Record: Implications for Research on Sexual Minorities Within an Integrated Health Care Delivery System. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1334] [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] Open
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Lue TW, Pantenburg DP, Crawford PM. Impact of the owner-pet and client-veterinarian bond on the care that pets receive. J Am Vet Med Assoc 2008; 232:531-40. [DOI: 10.2460/javma.232.4.531] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Arroyo S, Boothman BR, Brodie MJ, Duncan JS, Duncan R, Nieto M, Calandre EP, Forcadas I, Crawford PM. A randomised open-label study of tiagabine given two or three times daily in refractory epilepsy. Seizure 2005; 14:81-4. [PMID: 15694559 DOI: 10.1016/j.seizure.2004.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Efficacy and tolerability of tiagabine was evaluated in patients with non-controlled partial seizures in a multicentre, open-label, parallel group study. Tiagabine was administered either two (b.i.d.) or three times daily (t.i.d.) as adjunctive therapy and titrated stepwise to a target of 40 mg/day during a 12-week, fixed-schedule titration period; this was followed by a 12-week flexible continuation period. The primary efficacy endpoint was the proportion of patients completing the fixed-schedule titration period. A total of 243 patients were randomised and received treatment, 123 to b.i.d. and 120 to t.i.d. dosing. Fewer patients in the b.i.d. (76 and 62%) than in the t.i.d. (87 and 72%) group completed the fixed-schedule titration period (OR: 0.562; 95% CI: 0.309-1.008; P=0.0532). The median percentage decrease in all types of seizure (excluding status epilepticus) during the fixed schedule titration period was 33.4% for the b.i.d. and 23.8% for the t.i.d. groups (P=0.9634; Van Elteren's test). The proportion of responders was similar for the b.i.d. and t.i.d. groups. There were no significant differences between dosage regimens in the change in median seizure rates from baseline. Adverse events were more frequent during the titration than the continuation period. Most events were mild and related to the central nervous system. Although their incidence was similar between treatment groups, severity was more frequent in the b.i.d. group. Our results suggest that during titration tiagabine is better tolerated with t.i.d. dosing, but during long-term maintenance, a t.i.d. schedule is as effective and well tolerated as b.i.d.
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Affiliation(s)
- S Arroyo
- Hospital Clinico de Barcelona, Servicio de Neurologia, C/Villarroel 170, 08036 Barcelona, Spain
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Chadwick DW, Betts TA, Boddie HG, Crawford PM, Lindstrom P, Newman PK, Soryal I, Wroe S, Holdich TAH. Remacemide hydrochloride as an add-on therapy in epilepsy: a randomized, placebo-controlled trial of three dose levels (300, 600 and 1200 mg/day) in a Q.I.D. regimen. Seizure 2002; 11:114-23. [PMID: 11945098 DOI: 10.1053/seiz.2002.0588] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Remacemide hydrochloride is a low-affinity, non-competitive N-methyl-D-aspartic acid (NMDA) receptor channel blocker, under investigation in epilepsy. This double-blind, placebo-controlled, multicentre study assessed the safety and efficacy of remacemide hydrochloride or placebo, as adjunctive therapy, in 252 adult patients with refractory epilepsy who were already taking up to three antiepileptic drugs (including an enzyme-inducer). Patients were randomized to one of three doses of remacemide hydrochloride (300, 600 or 1200 mg /day) or placebo Q.I.D., for up to 15 weeks. An increasing percentage of responders (defined as a reduction in seizure frequency from baseline of > or =50%) was seen with increasing remacemide hydrochloride dose. At 1200 mg /day, 23% of patients were responders compared with 7% on placebo. This difference was significant (P = 0.016), as was the overall difference between treatments (P = 0.038). Adverse events: dizziness, abnormal gait, gastrointestinal disturbance, somnolence, diplopia and fatigue were mild or moderate in severity. Carbamazepine and phenytoin plasma concentrations were well controlled and maintained within target ranges, with no evidence of improved seizure control due to increases in the concentrations of these drugs. A dose-dependent, significant, increase in responders following adjunctive remacemide hydrochloride compared with placebo was observed. Remacemide hydrochloride was well tolerated.
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Lande RG, Crawford PM, Ramsey BJ. Psychosocial impact of vascular birthmarks. Facial Plast Surg Clin North Am 2001; 9:561-7. [PMID: 17590942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- R G Lande
- Department of Neuropsychiatry, University of South Carolina School of Medicine, USA
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Crawford PM, Conway MD, Peyman GA. Trauma-induced Acinetobacter lwoffi endophthalmitis with multi-organism recurrence: strategies with intravitreal treatment. Eye (Lond) 2001; 11 ( Pt 6):863-4. [PMID: 9537147 DOI: 10.1038/eye.1997.221] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endophthalmitis and its treatment are challenging, controversial subjects. We report here a patient whose recurrent endophthalmitis required several modes of treatment.
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Affiliation(s)
- P M Crawford
- LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112-2234, USA
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Trimble MR, Rüsch N, Betts T, Crawford PM. Psychiatric symptoms after therapy with new antiepileptic drugs: psychopathological and seizure related variables. Seizure 2000; 9:249-54. [PMID: 10880283 DOI: 10.1053/seiz.2000.0405] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this paper is to understand the association between antiepileptic drugs (AEDs), patient characteristics, changes in seizure pattern and emergent psychiatric disorder, i.e. psychosis or affective disorder. To this end we carried out a retrospective casenote study on 89 patients who developed psychiatric symptoms during treatment with topiramate, vigabatrin or tiagabine. The psychiatric problem was either an affective or a psychotic disorder (not including affective psychoses). It was discovered that 99% of the patients suffered from complex partial seizures with or without secondary generalization. More than half were on polytherapy with two or more other AEDs. Nearly two-thirds had a previous psychiatric history. There was a strong association between the type of previous psychiatric illness and the type of emerging psychiatric problem, both for psychoses and for affective disorders. Patients on vigabatrin had an earlier onset of epilepsy and more neurological abnormalities than those on topiramate. Those patients on lower doses had a shorter interval between the start of the AED therapy and the onset of the psychiatric problem. A seizure-free period was observed in more than half of the patients before they developed the psychiatric symptoms, and of these more were likely to develop a psychosis rather than an affective disorder. There seemed to be an association of suppression of right-sided seizures and the onset of the psychiatric problem. The conclusions drawn were that patients with a previous history of psychosis or affective disorder tended to develop the same psychiatric problem with new AEDs. Those with a seizure-free period before the onset of the psychiatric problem were more likely to develop a psychosis than an affective disorder.
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Affiliation(s)
- M R Trimble
- Institute of Neurology, Queen Square, London WC1N 3BG, UK.
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Abstract
Five antiepileptic drugs have been marketed in the last decade. We report here a retrospective study of patients attending our unit who were prescribed one of the new antiepileptic drugs. All these patients had refractory localization related epilepsy and had failed to respond to a first-line drug. The drugs had a different profile of side-effects but topiramate (42%) was the most common drug to be withdrawn due to side-effects as compared with tiagabine (26%), vigabatrin (16%), gabapentin (16%), and lamotrigine (15%). With regard to efficacy, 31% of the patients receiving gabapentin had a greater than 50% reduction in seizures compared with lamotrigine (25%), topiramate (20%), vigabatrin (19%) and tiagabine (11%). The number of patients remaining seizure free with gabapentin was 8% whilst for lamotrigine this was 5%, vigabatrin 5%, topiramate 1% and tiagabine 4%. In conclusion, all these five antiepileptic drugs are useful in treating refractory localization related epilepsy.
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Affiliation(s)
- P K Datta
- Department of Neurosciences, York District Hospital, York, UK.
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Kargotich S, Goodman C, Keast D, Fry RW, Garcia-Webb P, Crawford PM, Morton AR. Influence of exercise-induced plasma volume changes on the interpretation of biochemical data following high-intensity exercise. Clin J Sport Med 1997; 7:185-91. [PMID: 9262885 DOI: 10.1097/00042752-199707000-00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [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: 02/05/2023]
Abstract
OBJECTIVE To assess the effects that exercise-induced plasma volume changes (PVCs) have on the interpretation of biochemical and hormonal parameters in the blood of athletes after high-intensity exercise. It was hypothesized that two unrelated high-intensity exercise protocols, performed by two separate subject groups each using different exercise modes, would result in similar percentage changes in plasma volume (% delta PV). It was further hypothesized that the % delta PV, measured in both protocols, would comparably influence the interpretation of biochemical variables measured following exercise. DESIGN An experimental before-after trial on volunteers was performed. Two different exercise modes employing two different high-intensity acute exercise protocols were investigated. Eight male swimmers performed an interval training session (ITS) consisting of 15 x 100-m freestyle efforts at 95% of their maximal exercise intensity, and eight male runners performed a multistage discontinuous treadmill test (MSD) to volitional exhaustion. SETTING The Human Performance Laboratory at the Department of Human Movement at the University of Western Australia. MAIN OUTCOME MEASURES Blood samples obtained before, immediately after, and 30, 60, and 120 min during recovery were analyzed for plasma volume changes, urea, uric acid, creatinine, albumin, calcium, iron, transferrin, testosterone, cortisol, and sex hormone-binding globulin (SHBG). MAIN RESULTS The ITS and MSD protocols produced similar and significant alterations (p < 0.01) in plasma volume. Both protocols also elicited significant fluctuations (p < 0.01) in the concentration of most of the parameters measured (excluding iron). When albumin, transferrin, testosterone, and SHBG values were adjusted for the significant % delta PV, their concentrations did not change over the experimental period, suggesting that the changes in measured concentration of these parameters may be, in part, due to changes in plasma volume. However, urea, uric acid, creatinine, calcium, and cortisol, when corrected for % delta PVC, still demonstrated significant changes (p < 0.01). CONCLUSIONS It is recommended, when sampling biochemical and hormonal parameters in blood following an acute bout of exercise, that corrections for PVCs should be conducted. Apparent changes in blood solutes may reflect PVCs. PVCs should be taken into consideration when interpreting results regardless of exercise protocol and exercise mode performed.
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Affiliation(s)
- S Kargotich
- Department of Microbiology, University of Western Australia, Nedlands
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Wylie KR, Jackson C, Crawford PM. Does psychological testing help to predict the response to acupuncture or massage/relaxation therapy in patients presenting to a general neurology clinic with headache? J TRADIT CHIN MED 1997; 17:130-9. [PMID: 10437184] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Patients with chronic headache were offered treatment by acupuncture or massage with relaxation instead of a change in their prescribed medication. They were randomly allocated to either treatment. There was a significant improvement in pain ratings with both treatment types. Specifically a greater effect was seen in migraine patients treated by massage with relaxation when compared to acupuncture. No psychological factors were found to predict response to either treatment. At the end of the study, 13% of patients were significantly more worried that there may be a more serious cause underlying their headache despite reassurance and an improvement in their headache scores.
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Affiliation(s)
- K R Wylie
- Department of Neuropsychiatry, Bootham Park Hospital, York, U.K
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Clarke CE, Crawford PM, Clarke AM, Dockey D, Bridges LR. Retrospective diagnosis of fatal herpes simplex myelitis by immunocytochemistry and polymerase chain reaction. J Neurol Neurosurg Psychiatry 1994; 57:1272-3. [PMID: 7931397 PMCID: PMC485504 DOI: 10.1136/jnnp.57.10.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Dawkins JL, Crawford PM, Stammers TG. Epilepsy: a general practice study of knowledge and attitudes among sufferers and non-sufferers. Br J Gen Pract 1993; 43:453-7. [PMID: 8292416 PMCID: PMC1372483] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to examine epilepsy sufferers' attitudes to and knowledge of their condition, the effect of epilepsy on their lives and their views on the management they had received, and to compare knowledge and attitudes with those of a control group of non-sufferers. A questionnaire was completed by 29 patients with epilepsy and 32 control group subjects from two general practices. It was found that people with epilepsy knew little more than those without epilepsy regarding the nature of the condition, its aetiology and seizure precipitants. Those with epilepsy were concerned about the seizures and the effect these had on various aspects of their lives, and were concerned about long-term side effects of anti-epileptic medication. There were no significant differences between the two groups with respect to educational achievement, employment record and social activities. The findings are discussed and suggestions put forward for improving the care offered to epilepsy sufferers by both general practitioners and hospital clinics.
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Abstract
In controlled trials of antiepileptic drugs (AEDs) seizure frequency is often the only variable considered. With little prospect of improving assessment of AEDs, using seizure counts as the only end-point, there is a need for the development of new outcome measures. Clinical experience indicates that seizure severity is equally important to the patient and, by preventing seizure spread, AEDs can influence seizure severity without necessarily reducing seizure frequency. A scale capable of measuring seizure severity and change of severity attributable to treatment could be a useful additional outcome measure. Such a scale should exhibit the basic properties of validity and reliability. An easily administrable 16-point scale, containing 2 subscales--perception of control and ictal/post-ictal effects--has been developed. This scale has been tested on a patient population (n = 159) representative of that seen in trials of novel AEDs. Using standardised statistical methods, the scale has been shown to be both reliable and valid.
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Affiliation(s)
- G A Baker
- University Department of Neurosciences, Walton Hospital, Liverpool, U.K
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23
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Abstract
The differing actions of phenytoin, carbamazepine and sodium valproate on growth hormone release were studied in 20 patients with recently diagnosed epilepsy using diazepam, clonidine and glucagon as stimulatory tests of growth hormone response. The results are compared with the growth hormone response obtained pre treatment, and those from 20 control patients and 11 patients with chronic treated epilepsy. There was a reduction in growth hormone response to diazepam in both treated and untreated patients with epilepsy compared to controls. Treatment with phenytoin resulted in a significant increase in growth hormone release after diazepam and glucagon, whilst sodium valproate reduced the growth hormone response to diazepam.
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Affiliation(s)
- P M Crawford
- Mersey Regional Centre for Medical and Surgical Neurology, Walton Hospital, Liverpool, U.K
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Abstract
Amino acid concentrations were measured in CSF samples obtained by lumbar puncture in 51 patients, cervical puncture in 16 patients, spinal drains in nine patients, ventricular taps in five patients and from below a spinal block in six patients. There was evidence of a rostrocaudal gradient for GABA and taurine and a reverse gradient for alanine and asparagine. Lumbar CSF glycine concentrations rose with increasing age whilst GABA concentrations fell. Women had significantly lower concentrations of asparagine and glutamine and elevated taurine compared to men. The influence of biological factors and gradients must be taken into account before the interpretation of changes in CSF amino acid concentrations.
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Affiliation(s)
- P M Crawford
- Mersey Regional Medical and Surgical Neurology Unit, Walton Hospital, Liverpool, UK
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Abstract
Lumbar free CSF GABA and amino acid concentrations were measured in 43 patients with newly diagnosed untreated epilepsy and 26 patients with chronic drug-resistant epilepsy. The results were compared with those from 51 control patients. No differences in free CSF GABA concentration could be detected between patients with epilepsy, either treated or untreated, and controls. Untreated patients with primary generalised epilepsy and partial seizures had similar free CSF GABA concentrations. These results would not support the hypothesis that patients with epilepsy have a global disturbance of GABA function. CSF taurine, asparagine, aspartate, glycine and alanine were significantly reduced in patients with epilepsy compared to the control population.
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Affiliation(s)
- P M Crawford
- Mersey Regional Department of Medical and Surgical Neurology, Walton Hospital, Liverpool, U.K
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Abstract
Sixty-one patients of a population of 343 with cerebral arteriovenous malformations (AVMs) were diagnosed with seizures. Their AVMs were larger (p less than 0.02) and more frequently superficial (p less than 0.05) as compared with the AVMs of patients who were diagnosed with haemorrhage. The factors influencing the development of denovo seizures in patients with diagnosed AVMs were surgical treatment, a presentation with haemorrhage, and age at diagnosis.
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Abstract
Two-hundred and seventeen patients from a total population of 343 patients with arteriovenous malformations, were managed without surgery. Follow up was for a mean of 10.4 years. Using life survival analyses, there was a 42% risk of haemorrhage, 29% risk of death, 18% risk of epilepsy and a 27% risk of having a neurological handicap by 20 years after diagnosis in unoperated patients.
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Crawford PM, Hurst RV. Survey of state funds available for rehabilitation of patients with cleft lip/palate. Community Dent Oral Epidemiol 1978; 6:57-61. [PMID: 275017 DOI: 10.1111/j.1600-0528.1978.tb01121.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An effort was made to determine the amount of funds budgeted in each of the 50 U.S. states for total rehabilitation of patients with cleft lip and/or cleft palate. Questionnaires were sent following a pilot letter to the directors of each state Department of Health. Total funds per patient ranged from $17,442 for Delaware to a low of $426 for Wisconsin. Dental funds per patient ranged from $4,214 dollars for Wyoming to a low of $192 for New York.
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