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Andrews JS, Ryan AL, Elliott VS, Brotherton SE. Easing the Entry of Qualified International Medical Graduates to U.S. Medical Practice. Acad Med 2024; 99:35-39. [PMID: 37369075 DOI: 10.1097/acm.0000000000005310] [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] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Almost one quarter of physicians and physicians-in-training in the United States are international medical graduates (IMGs), meaning they have graduated from a medical school not accredited in the United States. Some IMGs are U.S. citizens and others are foreign nationals. IMGs, many of whom have years of training and experience gained in their countries of origin, have long contributed to the U.S. health care system, especially by providing care to populations that have been historically underserved. Additionally, many IMGs contribute to the diversity of the health care workforce, which can enhance the health of the population. The diversity of the United States is increasing, and racial and ethnic concordance between a physician and a patient has been linked to improved health outcomes.IMGs must meet national- and state-level licensing and credentialing standards like any other U.S. physician. This assures the ongoing quality of the care provided by the medical workforce and protects the public. However, at the state level, variation in standards and standards that may be more challenging to meet than those for U.S. medical school graduates may hamper IMGs' contributions. IMGs who are not U.S. citizens also face visa and immigration barriers.In this article, the authors present insights gleaned from Minnesota's model IMG integration program as well as changes made in 2 states in response to the COVID-19 pandemic. Improving and streamlining processes for IMGs to be licensed and credentialed as well as the policies governing visas and immigration, where appropriate, can ensure that IMGs will be willing and able to continue to practice when and where they are needed. This, in turn, could increase the contribution of IMGs to addressing health care inequities, improving health care access through service in federally designated Health Professional Shortage Areas, and reducing the impact of potential physician shortages.
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Santen SA, Van Rite E, Hammoud M, Lomis KD, Elliott VS, Heckman K, Andrews JS, Ayala SB, Richardson J. Supporting Medical Education Innovation: Evaluation of a Grants Initiative. Acad Med 2023; 98:1159-1163. [PMID: 37232755 DOI: 10.1097/acm.0000000000005279] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PROBLEM Medical education must evolve to meet the changing needs of patients and communities. Innovation is a critical component of that evolution. As medical educators pursue innovative curricula, assessments, and evaluation techniques, the impact of innovations may be limited by minimal funding. The American Medical Association (AMA) Innovation Grant Program, launched in 2018, seeks to address the gap in funding and stimulate educational innovation and research in medical education. APPROACH In 2018 and 2019, the Innovation Grant Program targeted innovation in content areas including health systems science, competency-based medical education, coaching, learning environment, and emerging technology. The authors reviewed the content of applications and final reports for the 27 projects completed during the first 2 years of the program. They also noted measures of success (completion of project, achievement of grant objectives, development of transferrable educational product, dissemination). OUTCOMES In 2018, the AMA received 52 submissions and funded 13 proposals, dispersing $290,000 ($10,000 and $30,000 grants). In 2019, the AMA received 80 submissions and funded 15 proposals, dispersing $345,000. Among the 27 completed grants, 17 (63%) supported innovations related to health systems science. Fifteen (56%) were used to create educational products that could be shared, such as new assessment tools, curricula, and teaching modules. Five grant recipients (29%) published articles and 15 (56%) presented at national conferences. NEXT STEPS The grant program advanced educational innovations, particularly in health systems science. The next steps will involve examining the long-term outcomes and impact of the completed projects on medical students, patients, and the health system; the professional development of the grantees; and the adoption and dissemination of the innovations.
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Affiliation(s)
- Sally A Santen
- S.A. Santen is professor, Emergency Medicine and Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio, senior associate dean, Virginia Commonwealth University School of Medicine, Richmond, Virginia, and senior advisor, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org.0000-0002-8327-8002
| | - Eric Van Rite
- E. Van Rite is preclerkship assessment manager, Rush Medical College, Chicago, Illinois. The author was senior research associate, American Medical Association, Chicago, Illinois, at the time of writing
| | - Maya Hammoud
- M. Hammoud is J. Robert Willson Research Professor of Obstetrics and Gynecology, professor of learning health sciences, chief, Women's Health Division, and associate chair, Education, University of Michigan Medical School, Ann Arbor, Michigan, and senior advisor for medical education innovation, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-7829-7930
| | - Kimberly D Lomis
- K.D. Lomis is vice president, Undergraduate Medical Education Innovations, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-3504-6776
| | - Victoria Stagg Elliott
- V.S. Elliott is a technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1223-0084
| | - Kevin Heckman
- K. Heckman is director of product development, Medical Education Outcomes, American Medical Association, Chicago, Illinois
| | - John S Andrews
- J.S. Andrews is vice president, Graduate Medical Education Innovations, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-2008-2686
| | - Sarah B Ayala
- S.B. Ayala is project manager, Medical Education Outcomes, American Medical Association, Chicago, Illinois
| | - Judee Richardson
- J. Richardson is director of research and program evaluation, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-5869-4293
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Skochelak SE, Lomis KD, Andrews JS, Hammoud MM, Mejicano GC, Byerley J. Realizing the vision of the Lancet Commission on Education of Health Professionals for the 21st Century: Transforming medical education through the Accelerating Change in Medical Education Consortium. Med Teach 2021; 43:S1-S6. [PMID: 34291718 DOI: 10.1080/0142159x.2021.1935833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the last two decades, prompted by the anticipated arrival of the 21st Century and on the centenary of the publication of the Flexner Report, many in medical education called for change to address the expanding chasm between the requirements of the health care system and the educational systems producing the health care workforce. Calls were uniform. Curricular content was missing. There was a mismatch in where people trained and where they were needed to practice, legacy approaches to pedagogical methods that needed to be challenged, an imbalance in diversity of trainees, and a lack of research on educational outcomes, resulting in a workforce that was described as ill-equipped to provide health care in the current and future environment. The Lancet Commission on Education of Health Professionals for the 21st Century published a widely acclaimed report in 2010 that called for a complete and authoritative re-examination of health professional education. This paper describes the innovations of the American Medical Association Accelerating Change in Medical Education Consortium schools as they relate to the recommendations of the Lancet Commission. We outline the successes, challenges, and lessons learned in working to deeply reform medical education.
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Affiliation(s)
- Susan E Skochelak
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - Kimberly D Lomis
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - John S Andrews
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - Maya M Hammoud
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - George C Mejicano
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Julie Byerley
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Andrews JS, Lomis KD, Richardson JA, Hammoud MM, Skochelak SE. Expanding innovation from undergraduate to graduate medical education: A path of continuous professional development. Med Teach 2021; 43:S49-S55. [PMID: 34291719 DOI: 10.1080/0142159x.2021.1935835] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A hundred years after the Flexner report laid the foundation for modern medical education, a number of authors commemorated the occasion by commenting on how the medical education system had to change once more to serve 21st century patients. Experts called for standardized outcomes and individualized learner pathways, integration of material across traditional areas, attention to an environment of inquiry, and professional identity formation. The medical education community responded and much has been achieved in the last decade, but much work remains to be done. In this paper we outline how the American Medical Association Accelerating Change in Medical Education Consortium, launched in 2013 through significant funding of transformation projects in undergraduate medical education, expanded its work into graduate medical education, and we look to the future of innovation in medical education.
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Affiliation(s)
- John S Andrews
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - Kimberly D Lomis
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - Judee A Richardson
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - Maya M Hammoud
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
| | - Susan E Skochelak
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
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Cullen MJ, Zhang C, Marcus-Blank B, Braman JP, Tiryaki E, Konia M, Hunt MA, Lee MS, Van Heest A, Englander R, Sackett PR, Andrews JS. Improving Our Ability to Predict Resident Applicant Performance: Validity Evidence for a Situational Judgment Test. Teach Learn Med 2020; 32:508-521. [PMID: 32427496 DOI: 10.1080/10401334.2020.1760104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Construct: We investigated whether a situational judgment test (SJT) designed to measure professionalism in physicians predicts residents' performance on (a) Accreditation Council for Graduate Medical Education (ACGME) competencies and (b) a multisource professionalism assessment (MPA). Background: There is a consensus regarding the importance of assessing professionalism and interpersonal and communication skills in medical students, residents, and practicing physicians. Nonetheless, these noncognitive competencies are not well measured during medical education selection processes. One promising method for measuring these noncognitive competencies is the SJT. In a typical SJT, respondents are presented with written or video-based scenarios and asked to make choices from a set of alternative courses of action. Interpersonally oriented SJTs are commonly used for selection to medical schools in the United Kingdom and Belgium and for postgraduate selection of trainees to medical practice in Belgium, Singapore, Canada, and Australia. However, despite international evidence suggesting that SJTs are useful predictors of in-training performance, end-of-training performance, supervisory ratings of performance, and clinical skills licensing objective structured clinical examinations, the use of interpersonally oriented SJTs in residency settings in the United States has been infrequently investigated. The purpose of this study was to investigate whether residents' performance on an SJT designed to measure professionalism-related competencies-conscientiousness, integrity, accountability, aspiring to excellence, teamwork, stress tolerance, and patient-centered care-predicts both their current and future performance as residents on two important but conceptually distinct criteria: ACGME competencies and the MPA. Approach: We developed an SJT to measure seven dimensions of professionalism. During calendar year 2017, 21 residency programs from 2 institutions administered the SJT. We conducted analyses to determine the validity of SJT and USMLE scores in predicting milestone performance in ACGME core competency domains and the MPA in June 2017 and 3 months later in September 2017 for the MPA and 1 year later, in June 2018, for ACGME domains. Results: At both periods, the SJT score predicted overall ACGME milestone performance (r = .13 and .17, respectively; p < .05) and MPA performance (r = .19 and .21, respectively; p < .05). In addition, the SJT predicted ACGME patient care, systems-based practice, practice-based learning and improvement, interpersonal and communication skills, and professionalism competencies (r = .16, .15, .15, .17, and .16, respectively; p < .05) 1 year later. The SJT score contributed incremental validity over USMLE scores in predicting overall ACGME milestone performance (ΔR = .07) 1 year later and MPA performance (ΔR = .05) 3 months later. Conclusions: SJTs show promise as a method for assessing noncognitive attributes in residency program applicants. The SJT's incremental validity to the USMLE series in this study underscores the importance of moving beyond these standardized tests to a more holistic review of candidates that includes both cognitive and noncognitive measures.
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Affiliation(s)
- Michael J Cullen
- Department of Graduate Medical Education, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Charlene Zhang
- Department of Psychology, University of Minnesota, Minnesota, USA
| | | | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ezgi Tiryaki
- Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mojca Konia
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Matthew A Hunt
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael S Lee
- Departments of Ophthalmology and Visual Neurosciences, Neurology and Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ann Van Heest
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Robert Englander
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Paul R Sackett
- Department of Psychology, University of Minnesota, Minnesota, USA
| | - John S Andrews
- GME Innovations, American Medical Association, Chicago, Illinois, USA
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Marcus-Blank B, Dahlke JA, Braman JP, Borman-Shoap E, Tiryaki E, Chipman J, Andrews JS, Sackett PR, Cullen MJ. Predicting Performance of First-Year Residents: Correlations Between Structured Interview, Licensure Exam, and Competency Scores in a Multi-Institutional Study. Acad Med 2019; 94:378-387. [PMID: 30157088 DOI: 10.1097/acm.0000000000002429] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To determine whether scores on structured interview (SI) questions designed to measure noncognitive competencies in physicians (1) predict subsequent first-year resident performance on Accreditation Council for Graduate Medical Education (ACGME) milestones and (2) add incremental validity over United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge scores in predicting performance. METHOD The authors developed 18 behavioral description questions to measure key noncognitive competencies (e.g., teamwork). In 2013-2015, 14 programs (13 residency, 1 fellowship) from 6 institutions used subsets of these questions in their selection processes. The authors conducted analyses to determine the validity of SI and USMLE scores in predicting first-year resident milestone performance in the ACGME's core competency domains and overall. RESULTS SI scores predicted midyear and year-end overall performance (r = 0.18 and 0.19, respectively, P < .05) and year-end performance on patient care, interpersonal and communication skills, and professionalism competencies (r = 0.23, r = 0.22, and r = 0.20, respectively, P < .05). SI scores contributed incremental validity over USMLE scores in predicting year-end performance on patient care (ΔR = 0.05), interpersonal and communication skills (ΔR = 0.09), and professionalism (ΔR = 0.09; all P < .05). USMLE scores contributed incremental validity over SI scores in predicting year-end performance overall and on patient care and medical knowledge. CONCLUSIONS SI scores predict first-year resident year-end performance in the interpersonal and communication skills, patient care, and professionalism competency domains. Future research should investigate whether SIs predict a range of clinically relevant outcomes.
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Affiliation(s)
- Brittany Marcus-Blank
- B. Marcus-Blank was a graduate student, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota, at the time of the study. The author is now senior analyst, Talent Assessment and Coaching, General Mills, Minneapolis, Minnesota. J.A. Dahlke is a graduate student, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota. J.P. Braman is associate professor, Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota. E. Borman-Shoap is assistant professor and vice chair for education, Department of Pediatrics, and program director, Pediatrics Residency Program, University of Minnesota Medical School, Minneapolis, Minnesota. E. Tiryaki is associate professor, Department of Neurology, University of Minnesota Medical School, and associate chief of staff for education, Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, Minnesota. J. Chipman is professor and vice chair for education, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota. J.S. Andrews is vice president, GME Innovations, American Medical Association, Chicago, Illinois. P.R. Sackett is professor of psychology, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota. M.J. Cullen is director of evaluation for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota
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Affiliation(s)
- Barry L. Johnson
- Assistant Surgeon General Assistant Administrator Agency for Toxic Substances and Disease Registry
| | - John S. Andrews
- Associate Administrator for Science Agency for Toxic Substances and Disease Registry
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Kahle-Wrobleski K, Andrews JS, Belger M, Ye W, Gauthier S, Rentz DM, Galasko D. Dependence Levels as Interim Clinical Milestones Along the Continuum of Alzheimer's Disease: 18-Month Results from the GERAS Observational Study. J Prev Alzheimers Dis 2018; 4:72-80. [PMID: 29186278 DOI: 10.14283/jpad.2017.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND While functional loss forms part of the current diagnostic criteria used to identify dementia due to Alzheimer's disease, the gradual and progressive nature of the disease makes it difficult to recognize clinically relevant signposts that could be helpful in making treatment and management decisions. Having previously observed a significant relationship between stages of functional dependence (the level of assistance patients require consequent to Alzheimer's disease deficits, derived from the Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale) and cognitive severity, we investigated whether measures of functional dependence could be utilized to identify clinical milestones of Alzheimer's disease progression. OBJECTIVES To describe the patterns of change in dependence over the course of 18 months in groups stratified according to cognitive Alzheimer's disease dementia severity (determined using the Mini-Mental State Examination score) and to identify characteristics associated with patients showing worsening dependence (progressors) versus those showing no change or improvement (non-progressors). DESIGN Analysis of longitudinal data from the GERAS study. SETTING GERAS is an 18-month prospective, multicenter, naturalistic, observational cohort study reflecting the routine care of patients with Alzheimer's disease in France, Germany, and the United Kingdom. PARTICIPANTS 1495 community-living patients, aged ≥55 years, diagnosed with probable Alzheimer's disease dementia, and their caregivers. MEASUREMENTS Dependence levels, cognitive function, behavioral symptoms, caregiver burden, and cost were assessed at baseline and at 18 months. RESULTS Of 971 patients having both baseline and 18-month data, 42% (408) were progressors and 563 (58%) were non-progressors. This general pattern held for all three levels of baseline Alzheimer's disease dementia severity - mild (Mini-Mental State Examination score 21-26), moderate (15-20) or moderately severe/severe (<15) - with 40-45% of each group identified as progressors and 55-60% as non-progressors. No baseline differences were seen between progressors and non-progressors in cognitive scores or behavioral symptoms, although progressors had significantly shorter times since diagnosis and showed milder functional impairment. Baseline factors predictive of increasing dependence over 18 months included more severe cognitive impairment, living with others, and having multiple caregivers. A higher level of initial dependence was associated with less risk of dependence progression. Total societal costs of care also increased with greater dependence. CONCLUSIONS In this large cohort, 42% of Alzheimer's disease dementia patients at all levels of cognitive severity became more dependent within 18 months of observation while 58% did not progress. Dependence levels may be considered as meaningful interim clinical milestones that reflect Alzheimer's disease-related functional deficits, although a time frame that extends beyond 18 months may be necessary to observe changes if used in clinical trials or other longitudinal studies. Recognition of predictors of greater dependence offers opportunities for intervention.
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Affiliation(s)
- K Kahle-Wrobleski
- Kristin Kahle-Wrobleski, PhD, Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis IN 46285, USA, Phone: 317-651-9881, Fax: 317-276-5791,
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Pappas DA, Gerber RA, Litman HJ, Gruben D, Geier J, Hua WD, Chen C, Li Y, Kremer JM, Andrews JS, Bourret JA. Delayed Treatment Acceleration in Patients with Rheumatoid Arthritis Who Have Inadequate Response to Initial Tumor Necrosis Factor Inhibitors: Data from the Corrona Registry. Am Health Drug Benefits 2018; 11:148-158. [PMID: 29910846 PMCID: PMC5973251] [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] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The implementation of treat-to-target principles in rheumatoid arthritis (RA) has not been fully investigated in patients with inadequate response to tumor necrosis factor (TNF) inhibitor treatment. OBJECTIVES To evaluate the prevalence of an inadequate response to initial TNF inhibitor treatment at 6 and 12 months among patients with RA in a real-world patient registry, as well as the delay in therapy adjustment and its impact on disease activity and patient-reported outcome (PRO) measures. METHODS This analysis is based on data of patients with moderate or severe disease activity (Clinical Disease Activity Index [CDAI] score >10) who were included in the Consortium of Rheumatology Researchers of North America (Corrona) RA registry, a prospective, observational database. The patients had never received treatment with a biologic disease-modifying antirheumatic drug (DMARD) and had initiated treatment with a TNF inhibitor (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) between October 2001 and December 2014. We evaluated treatment response (CDAI score ≤10), select PRO measures, and treatment changes at 6 months. Patients who had an inadequate response to TNF inhibitor therapy at 6 months and continued to use their initial TNF inhibitor were evaluated again at 12 months. RESULTS This retrospective analysis included 2282 patients. At 6 months, 1732 (75.9%) of the patients continued to use their initial TNF inhibitor; of these, 803 (46.4%) patients had an inadequate response to treatment. Of the 803 patients who had an inadequate response at 6 months, 488 (60.8%) continued their initial treatment at 12 months. Of these 488 patients, 315 (64.5%) had an inadequate response at 12 months, and 173 (35.5%) had a response. Numerically greater improvements in all PRO measures were observed for patients who responded to therapy compared with patients with an inadequate response. CONCLUSIONS In this real-world analysis of data from the Corrona RA registry, a considerable proportion of patients with RA had an inadequate response to the initial TNF inhibitor therapy at 6 and 12 months. Many patients continued to have moderate or high disease activity, without accelerating treatment (eg, addition or increase in the dose of concurrent conventional synthetic DMARDs or a TNF inhibitor), contrary to treat-to-target principles, thus remaining at risk for accumulating joint damage and disability.
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Affiliation(s)
- Dimitrios A Pappas
- Scientific Director of International Registry and Comparative Effectiveness and Biomarkers Sub-Study, Corrona, Waltham, MA, and Assistant Professor of Medicine, Department of Medicine, Columbia University, New York City
| | - Robert A Gerber
- Senior Director, Health Economics and Outcomes Research, Pfizer, Groton, CT
| | | | | | - Jamie Geier
- Director of Epidemiology, Pfizer, New York City
| | | | - Connie Chen
- Senior Medical Director, Global Medical Affairs, Pfizer, New York City
| | - Youfu Li
- Biostatistician III, University of Massachusetts Medical School, Worcester
| | - Joel M Kremer
- Chief Medical Officer, Corrona, and Professor of Medicine, Albany Medical College, NY
| | - John S Andrews
- Senior Director, US Medical Affairs, Pfizer, Collegeville, PA
| | - Jeffrey A Bourret
- Senior Director, North America Medical Affairs, and Medical Lead, Specialty Payer & Channel Customer Strategy, Pfizer, Collegeville, PA
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Andrews JS, Bale JF, Soep JB, Long M, Carraccio C, Englander R, Powell D. Education in Pediatrics Across the Continuum (EPAC): First Steps Toward Realizing the Dream of Competency-Based Education. Acad Med 2018; 93:414-420. [PMID: 29023245 DOI: 10.1097/acm.0000000000002020] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The Education in Pediatrics Across the Continuum (EPAC) Study Group is developing the first competency-based, time-variable progression from undergraduate medical education (UME) to graduate medical education (GME) in the history of medical education in the United States. EPAC, an innovation project sponsored by the Association of American Medical Colleges and supported by the Josiah Macy Jr. Foundation, was developed through a collaboration between five medical schools and multiple professional organizations with an interest in undergraduate and graduate medical education. The planning and implementation process demanded cooperatively addressing practical barriers such as education requirements for licensure and developing approaches to learner assessment that provided meaningful information about competency. Each participating school now has at least three cohorts of learners participating, and the program is transitioning its first cohort of students from UME to GME based on achievement of predetermined competencies that allow this transition. Members of the first cohort of learners in this program have begun their pediatric residency training at different times beginning in late 2016, confirming the feasibility of competency-based advancement from UME to GME in pediatrics. Although there is still much to learn about the outcomes of EPAC learners' professional development in residency training and beyond, EPAC has defined an operational approach to a different path through medical school and into residency training, based on the attainment of competence.
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Affiliation(s)
- John S Andrews
- J.S. Andrews is vice chair for education and associate professor, Department of Pediatrics, and associate dean for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: http://orcid.org/0000-0002-2008-2686. J.F. Bale is professor of pediatrics and neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. J.B. Soep is associate professor of pediatrics, Department of Pediatrics, and pediatric clerkship director, University of Colorado School of Medicine, Aurora, Colorado. M. Long is associate professor of pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8399-5589. C. Carraccio is vice president for competency-based assessment programs, American Board of Pediatrics, Chapel Hill, North Carolina. R. Englander is professor of pediatrics, Department of Pediatrics, and associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota. D. Powell is professor of laboratory medicine and pathology, Department of Laboratory Medicine and Pathology, and dean emerita, University of Minnesota Medical School, Minneapolis, Minnesota
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Cullen MJ, Konia MR, Borman-Shoap EC, Braman JP, Tiryaki E, Marcus-Blank B, Andrews JS. Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors. Med Teach 2017; 39:85-91. [PMID: 27670731 DOI: 10.1080/0142159x.2016.1231917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians. METHOD In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a "brief" and "extended" professionalism checklist for monitoring physician misconduct. RESULTS This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly. DISCUSSION Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.
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Affiliation(s)
- Michael J Cullen
- a Graduate Medical Education , University of Minnesota , Minneapolis , MN , USA
| | - Mojca R Konia
- b Department of Anesthesiology , University of Minnesota , Minneapolis , MN , USA
| | | | - Jonathan P Braman
- d Department of Orthopaedic Surgery , University of Minnesota , Minneapolis , MN , USA
| | - Ezgi Tiryaki
- e Minneapolis VA Health Care System , Minneapolis , MN , USA
- f Department of Neurology, University of Minnesota , Minneapolis , MN , USA
| | | | - John S Andrews
- a Graduate Medical Education , University of Minnesota , Minneapolis , MN , USA
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Affiliation(s)
- Barry L. Johnson
- Agency for Toxic Substances and Disease Registry Public Health Service U.S. Department of Health and Human Services Atlanta, Georgia
| | - Charles Xintaras
- Agency for Toxic Substances and Disease Registry Public Health Service U.S. Department of Health and Human Services Atlanta, Georgia
| | - John S. Andrews
- Agency for Toxic Substances and Disease Registry Public Health Service U.S. Department of Health and Human Services Atlanta, Georgia
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McDonald EM, Gielen AC, Trifiletti LB, Andrews JS, Serwint JR, Wilson MEH. Evaluation Activities to Strengthen an Injury Prevention Resource Center for Urban Families. Health Promot Pract 2016; 4:129-37. [PMID: 14610982 DOI: 10.1177/1524839902250761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Johns Hopkins Children’s Safety Center (CSC) is a unique health care provider and patient education resource that elevates the attention injury prevention receives in a medical setting and reduces barriers to injury prevention experienced by low-income, urban families, the Center’s priority population. This article describes the CSC’s development, implementation, and selected elements of its evaluation. Because evaluation has played an important role in the CSC from its inception through its implementation and sustainability, three evaluation activities are described: process evaluation to monitor activity, impact evaluation to understand its effects on parents’ safety behaviors, and qualitative interviews with CSC visitors and non-visitors to enhance services. Implications of each evaluation activity are described and recommendations are made for strengthening the CSC.
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Pusic MV, Chiaramonte R, Gladding S, Andrews JS, Pecaric MR, Boutis K. Accuracy of self-monitoring during learning of radiograph interpretation. Med Educ 2015; 49:838-846. [PMID: 26152495 DOI: 10.1111/medu.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/23/2015] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
CONTEXT Despite calls for the improvement of self-assessment as a basis for self-directed learning, instructional designs that include reflection in practice are uncommon. Using data from a screen-based simulation for learning radiograph interpretation, we present validity evidence for a simple self-monitoring measure and examine how it can complement skill assessment. METHODS Medical students learning ankle radiograph interpretation were given an online learning set of 50 cases which they were asked to classify as 'abnormal' (fractured) or 'normal' and to indicate the degree to which they felt certain about their response (Definitely or Probably). They received immediate feedback on each case. All students subsequently completed two 20-case post-tests: an immediate post-test (IPT), and a delayed post-test (DPT) administered 2 weeks later. We determined the degree to which certainty (Definitely versus Probably) correlated with accuracy of interpretation and how this relationship changed between the tests. RESULTS Of 988 students approached, 115 completed both tests. Mean ± SD accuracy scores decreased from 59 ± 17% at the IPT to 53 ± 16% at the DPT (95% confidence interval [CI] for the difference: -2% to -10%). Mean self-assessed certainty did not decrease (rates of Definitely: IPT, 17.6%; DPT, 19.5%; 95% CI for difference: +7.2% to -3.4%). Regression modelling showed that accuracy was positively associated with choosing Definitely over Probably (odds ratio [OR] 1.63, 95% CI 1.27-2.09) and indicated a statistically significant interaction between test timing and certainty (OR 0.72, 95% CI 0.52-0.99); thus, the accuracy of self-monitoring decayed over the retention interval, leaving students relatively overconfident in their abilities. CONCLUSIONS This study shows that, in medical students learning radiograph interpretation, the development of self-monitoring skills can be measured and should not be assumed to necessarily vary in the same way as the underlying clinical skill.
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Affiliation(s)
- Martin V Pusic
- Division of Education Quality and Analytics, School of Medicine, New York University, New York, NY, USA
| | - Robert Chiaramonte
- Downstate College of Medicine, State University of New York, New York, NY, USA
| | - Sophia Gladding
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - John S Andrews
- Office of Graduate Medical Education, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Kathy Boutis
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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16
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Kahle-Wrobleski K, Andrews JS, Belger M, Gauthier S, Stern Y, Rentz DM, Galasko D. Clinical and Economic Characteristics of Milestones along the Continuum of Alzheimer's Disease: Transforming Functional Scores into Levels of Dependence. J Prev Alzheimers Dis 2015; 2:115-120. [PMID: 28775969 DOI: 10.14283/jpad.2015.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Because Alzheimer's disease (AD) is characterized by a gradual decline, it can be difficult to identify distinct clinical milestones that signal disease advancement. Adapting a functional scale may be a useful way of staging disease progression that is more informative for healthcare systems. OBJECTIVES To adapt functional scale scores into discrete levels of dependence as a way of staging disease progression that is more informative to care providers and stakeholders who rely on the functional impact of diseases to determine access to supportive services and interventions. DESIGN Analysis of data from the GERAS study. SETTING GERAS is an 18-month prospective, multicenter, naturalistic, observational cohort study reflecting the routine care of patients with AD in France, Germany, and the United Kingdom. PARTICIPANTS Data were from baseline results of 1497 community-living patients, aged ≥55 years, diagnosed with probable AD and their caregivers. MEASUREMENTS We used data from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) and mapped items onto established categories of functional dependence, validated using clinical and economic measures. Cognitive function, behavioral symptoms, caregiver burden, and cost were assessed. Based on stages of functional dependence described by the Dependence Scale, individual ADCS-ADL items were used to approximate 6 dependence levels. RESULTS There was a significant relationship between assigned level of dependence derived from the ADCS-ADL score and cognitive severity category. As the assigned level of dependence increased, the associated clinical and economic indicators demonstrated a pattern of greater disease severity. CONCLUSIONS This mapping provides initial support for dependence levels as appropriate interim clinical milestones that characterize the functional deficits associated with AD.
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Affiliation(s)
| | - J S Andrews
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M Belger
- Lilly Research Centre, Windlesham, UK
| | - S Gauthier
- McGill University, Montreal, Quebec, Canada
| | - Y Stern
- Columbia University, New York, NY, USA
| | - D M Rentz
- Harvard Medical School, Boston, MA, USA
| | - D Galasko
- University of California San Diego, San Diego, CA, USA
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17
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Boutis K, Pecaric M, Shiau M, Ridley J, P Gladding S, S Andrews J, V Pusic M. A hinting strategy for online learning of radiograph interpretation by medical students. Med Educ 2013; 47:877-887. [PMID: 23931537 DOI: 10.1111/medu.12182] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/31/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT We examined whether a 'hint' manoeuvre increases the time novice medical learners spend on reviewing a radiograph, thereby potentially increasing their interpretation accuracy. METHODS Senior year medical students were recruited into a randomised control, three-arm, multicentre trial. Students reviewed an online 50-case learning set that varied in degree of 'hint' intervention. The 'hint' was a dialogue box that appeared after a student submitted an answer, encouraging the student to re-evaluate their interpretation. The students in the control group received no hints. In the weak intervention group, students received 'hints' with 66% of their incorrect interpretations and 33% of those that were correct. In the strong intervention group, the incorrect interpretation hint frequency was 80%, whereas for correct responses it was 20%. All students completed a 20-case post-test immediately and 2 weeks after the 50 cases. The primary outcome was student performance on the immediate post-test, measured as the ability to discriminate between normal and abnormal films (dPrime). Secondary outcomes included the probability of considering the hint, time spent on learning cases and knowledge retention at 2 weeks. RESULTS We enrolled 117 medical students from three sites into the three study groups: control (36), weak intervention (40) and strong intervention (41) groups. The mean (standard deviation) dPrime in the control, weak and strong groups were 0.4 (1.1), 0.7 (1.1) and 0.4 (0.9), respectively (P = 0.4). In the weak and strong groups, participants reconsidered answers in 556 of 1944 (28.6%) hinting opportunities, and those who reconsidered their answers spent a mean (95% confidence interval) of 13.9 (11.9, 16.0) seconds longer on each case. There were no significant differences in knowledge retention at 2 weeks between the groups (P = 0.2). CONCLUSIONS Although the implemented hinting strategy did result in students spending more time considering a proportion of the cases, overall it was not effective in improving student performance.
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Affiliation(s)
- Kathy Boutis
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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18
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Dabelea D, Mayer-Davis EJ, Andrews JS, Dolan LM, Pihoker C, Hamman RF, Greenbaum C, Marcovina S, Fujimoto W, Linder B, Imperatore G, D'Agostino R. Clinical evolution of beta cell function in youth with diabetes: the SEARCH for Diabetes in Youth study. Diabetologia 2012; 55:3359-68. [PMID: 22990715 PMCID: PMC4492685 DOI: 10.1007/s00125-012-2719-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/17/2012] [Indexed: 01/12/2023]
Abstract
AIMS/HYPOTHESIS Few studies have explored the epidemiology of beta cell loss in youth with diabetes. This report describes the evolution and major determinants of beta cell function, assessed by fasting C-peptide (FCP), in the SEARCH for Diabetes in Youth study. METHODS Participants were 1,277 youth with diabetes (948 positive for diabetes autoantibodies [DAs] and 329 negative for DAs), diagnosed when aged <20 years, who were followed from a median of 8 months post diagnosis, for approximately 30 months. We modelled the relationship between rate of change in log FCP and determinants of interest using repeated measures general linear models. RESULTS Among DA-positive youth, there was a progressive decline in beta cell function of 4% per month, independent of demographics (age, sex, race/ethnicity), genetic susceptibility to autoimmunity (HLA risk), HbA(1c) and BMI z score, or presence of insulin resistance. Among DA-negative youth, there was marked heterogeneity in beta cell loss, reflecting an aetiologically mixed group. This group likely includes youths with undetected autoimmunity (whose decline is similar to that of DA-positive youth) and youth with non-autoimmune, insulin-resistant diabetes, with limited decline (~0.7% per month). CONCLUSIONS/INTERPRETATION SEARCH provides unique estimates of beta cell function decline in a large sample of youth with diabetes, indicating that autoimmunity is the major contributor. These data contribute to a better understanding of clinical evolution of beta cell function in youth with diabetes, provide strong support for the aetiological classification of diabetes type and may inform tertiary prevention efforts targeted at high-risk groups.
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Affiliation(s)
- D Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Ave, Aurora, CO 80045, USA.
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19
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Bhatt DK, Gupta S, Jansen-Olesen I, Andrews JS, Olesen J. NXN-188, a selective nNOS inhibitor and a 5-HT1B/1D receptor agonist, inhibits CGRP release in preclinical migraine models. Cephalalgia 2012; 33:87-100. [PMID: 23155193 DOI: 10.1177/0333102412466967] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND NXN-188 is a combined neuronal nitric oxide synthase (nNOS) inhibitor and 5-hydroxytryptamine 1B/1D (5-HT1B/1D) receptor agonist. Using preclinical models, we evaluated whether these two unique therapeutic principles have a synergistic effect in attenuating stimulated calcitonin gene-related peptide (CGRP) release, a marker of trigeminal activation. METHODS We examined the effect of NXN-188 on: (1) KCl-, capsaicin- and resiniferatoxin (RTX)-induced immunoreactive CGRP (iCGRP) release from isolated preparation of rat dura mater, trigeminal ganglion (TG) and trigeminal nucleus caudalis (TNC); and (2) capsaicin- and electrical stimulation (ES)-induced middle meningeal artery (MMA) dilation in a rat closed-cranial window. RESULTS NXN-188 inhibited: (1) KCl-stimulated iCGRP release from dura mater (% decrease mean ± SEM, lowest effective concentration) (35 ± 6%, 30 µM), TG (24 ± 11%, 10 µM) and TNC (40 ± 8%, 10 µM); (2) capsaicin- and RTX-induced iCGRP release from dura mater; and (3) capsaicin- and ES-induced increase in dural artery diameter (32 ± 5%, 3 mg kg(-1) intravenous (i.v.) and 36 ± 1%, 10 mg kg(-1) i.v.). CONCLUSIONS NXN-188 inhibits CGRP release from migraine-relevant cephalic tissues. Its effect is most likely mediated via a combination of nNOS-inhibition and 5-HT1B/1D receptor agonism in dura mater while the mechanisms of action for inhibition of CGRP release from TG and TNC have to be investigated further.
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Affiliation(s)
- Deepak K Bhatt
- Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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20
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Annedi SC, Maddaford SP, Ramnauth J, Renton P, Rybak T, Silverman S, Rakhit S, Mladenova G, Dove P, Andrews JS, Zhang D, Porreca F. Discovery of a potent, orally bioavailable and highly selective human neuronal nitric oxide synthase (nNOS) inhibitor, N-(1-(piperidin-4-yl)indolin-5-yl)thiophene-2-carboximidamide as a pre-clinical development candidate for the treatment of migraine. Eur J Med Chem 2012; 55:94-107. [PMID: 22840695 DOI: 10.1016/j.ejmech.2012.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/01/2012] [Accepted: 07/04/2012] [Indexed: 10/28/2022]
Abstract
We recently reported a series of 1,6-disubstituted indoline-based thiophene amidine compounds (5) as selective neuronal nitric oxide synthase (nNOS) inhibitors to mitigate the cardiovascular liabilities associated with hERG K(+) channel inhibition (IC(50) = 4.7 μM) with previously reported tetrahydroquinoline-based selective nNOS inhibitors (4). The extended structure-activity relationship studies within the indoline core led to the identification of 43 as a selection candidate for further evaluations. The in vivo activity in two different pain (spinal nerve ligation and migraine pain) models, the excellent physicochemical and pharmacokinetic properties, oral bioavailability (F(po) = 91%), and the in vitro safety profile disclosed in this report make 43 an ideal candidate for further evaluation in clinical applications related to migraine pain.
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Affiliation(s)
- Subhash C Annedi
- NeurAxon Inc., 2395 Speakman Drive, Suite #1001, Mississauga, ON, Canada L5K 1B3.
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21
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Mladenova G, Annedi SC, Ramnauth J, Maddaford SP, Rakhit S, Andrews JS, Zhang D, Porreca F. First-in-class, dual-action, 3,5-disubstituted indole derivatives having human nitric oxide synthase (nNOS) and norepinephrine reuptake inhibitory (NERI) activity for the treatment of neuropathic pain. J Med Chem 2012; 55:3488-501. [PMID: 22420844 DOI: 10.1021/jm300138g] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A family of different 3,5-disubstituted indole derivatives having 6-membered rings were designed, synthesized, and demonstrated inhibition of human nitric oxide synthase (NOS) with norepinephrine reuptake inhibitory activity (NERI). The structure-activity relationship (SAR) within the cyclohexane ring showed the cis-isomers to be more potent for neuronal NOS and selective over endothelial NOS compared to their trans-counterparts. Compounds, such as cis-(+)-37, exhibited dual nNOS and NET inhibition (IC(50) of 0.56 and 1.0 μM, respectively) and excellent selectivity (88-fold and 12-fold) over eNOS and iNOS, respectively. The lead compound (cis-(+)-37) showed lack of any direct vasoconstriction or inhibition of ACh-mediated vasorelaxation in isolated human coronary arteries. Additionally, cis-(+)-37 was effective at reversing both allodynia and thermal hyperalgesia in a standard Chung (spinal nerve ligation) rat neuropathic pain model. Overall, the data suggest that cis-(+)-37 is a promising dual action development candidate having therapeutic potential for the treatment of neuropathic pain.
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Affiliation(s)
- Gabriela Mladenova
- NeurAxon Inc., 2395 Speakman Drive, Suite 1001, Mississauga, Ontario L5K 1B3, Canada.
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22
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Renton P, Green B, Maddaford S, Rakhit S, Andrews JS. NOpiates: Novel Dual Action Neuronal Nitric Oxide Synthase Inhibitors with μ-Opioid Agonist Activity. ACS Med Chem Lett 2012; 3:227-31. [PMID: 24900459 DOI: 10.1021/ml200268w] [Citation(s) in RCA: 16] [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: 11/10/2011] [Accepted: 01/19/2012] [Indexed: 01/06/2023] Open
Abstract
A novel series of benzimidazole designed multiple ligands (DMLs) with activity at the neuronal nitric oxide synthase (nNOS) enzyme and the μ-opioid receptor was developed. Targeting of the structurally dissimilar heme-containing enzyme and the μ-opioid GPCR was predicated on the modulatory role of nitric oxide on μ-opioid receptor function. Structure-activity relationship studies yielded lead compound 24 with excellent nNOS inhibitory activity (IC50 = 0.44 μM), selectivity over both endothelial nitric oxide synthase (10-fold) and inducible nitric oxide synthase (125-fold), and potent μ-opioid binding affinity, K i = 5.4 nM. The functional activity as measured in the cyclic adenosine monosphospate secondary messenger assay resulted in full agonist activity (EC50 = 0.34 μM). This work represents a novel approach in the development of new analgesics for the treatment of pain.
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Affiliation(s)
- Paul Renton
- NeurAxon Inc., 2395 Speakman
Drive, Suite #1001, Mississauga, Ontario, L5K 1B3, Canada
| | - Brenda Green
- NeurAxon Inc., 2395 Speakman
Drive, Suite #1001, Mississauga, Ontario, L5K 1B3, Canada
| | - Shawn Maddaford
- NeurAxon Inc., 2395 Speakman
Drive, Suite #1001, Mississauga, Ontario, L5K 1B3, Canada
| | - Suman Rakhit
- NeurAxon Inc., 2395 Speakman
Drive, Suite #1001, Mississauga, Ontario, L5K 1B3, Canada
| | - John S. Andrews
- NeurAxon Inc., 2395 Speakman
Drive, Suite #1001, Mississauga, Ontario, L5K 1B3, Canada
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23
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Pusic MV, Andrews JS, Kessler DO, Teng DC, Pecaric MR, Ruzal-Shapiro C, Boutis K. Prevalence of abnormal cases in an image bank affects the learning of radiograph interpretation. Med Educ 2012; 46:289-298. [PMID: 22324528 DOI: 10.1111/j.1365-2923.2011.04165.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Using a large image bank, we systematically examined how the use of different ratios of abnormal to normal cases affects trainee learning. METHODS This was a prospective, double-blind, randomised, three-arm education trial conducted in six academic training programmes for emergency medicine and paediatric residents in post-licensure years 2-5. We developed a paediatric ankle trauma radiograph case bank. From this bank, we constructed three different 50-case training sets, which varied in their proportions of abnormal cases (30%, 50%, 70%). Levels of difficulty and diagnoses were similar across sets. We randomly assigned residents to complete one of the training sets. Users classified each case as normal or abnormal, specifying the locations of any abnormalities. They received immediate feedback. All participants completed the same 20-case post-test in which 40% of cases were abnormal. We determined participant sensitivity, specificity, likelihood ratio and signal detection parameters. RESULTS A total of 100 residents completed the study. The groups did not differ in accuracy on the post-test (p = 0.20). However, they showed considerable variation in their sensitivity-specificity trade-off. The group that received a training set with a high proportion of abnormal cases achieved the best sensitivity (0.69, standard deviation [SD] = 0.24), whereas the groups that received training sets with medium and low proportions of abnormal cases demonstrated sensitivities of 0.63 (SD = 0.21) and 0.51 (SD = 0.24), respectively (p < 0.01). Conversely, the group with a low proportion of abnormal cases demonstrated the best specificity (0.83, SD = 0.10) compared with the groups with medium (0.70, SD = 0.15) and high (0.66, SD = 0.17) proportions of abnormal cases (p < 0.001). The group with a low proportion of abnormal cases had the highest false negative rate and missed fractures one-third more often than the groups that trained on higher proportions of abnormal cases. CONCLUSIONS Manipulating the ratio of abnormal to normal cases in learning banks can have important educational implications.
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Affiliation(s)
- Martin V Pusic
- Department of Paediatrics, Columbia University, New York, NY 10032, USA.
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24
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Annedi SC, Ramnauth J, Cossette M, Maddaford SP, Dove P, Rakhit S, Andrews JS, Porreca F. Novel, druglike 1,7-disubstituted 2,3,4,5-tetrahydro-1H-benzo[b]azepine-based selective inhibitors of human neuronal nitric oxide synthase (nNOS). Bioorg Med Chem Lett 2012; 22:2510-3. [PMID: 22370270 DOI: 10.1016/j.bmcl.2012.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 11/25/2022]
Abstract
A novel class of 1,7-disubstituted 2,3,4,5-tetrahydro-1H-benzo[b]azepine derivatives was designed, synthesized and evaluated as human nitric oxide synthase (NOS) inhibitors. Structure-activity relationship studies based on various basic amine side chains attached at the 1-position of the 2,3,4,5-tetrahydro-1H-benzo[b]azepine ring led to the identification of several potent and highly selective inhibitors (17, 18, 25, (±)-39, and (±)-40) of human neuronal NOS. The potential therapeutic application of one of these new selective nNOS inhibitors (17) was demonstrated in an in vivo spinal nerve ligation model of neuropathic pain, and various in vitro safety pharmacology studies such as the hERG K(+) channel inhibition assay and high throughput broad screen (minimal activity at 79 receptors/transporters/ion channels).
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Affiliation(s)
- Subhash C Annedi
- NeurAxon Inc., 2395 Speakman Drive, Suite # 1001, Mississauga, ON, Canada L5K 1B3.
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25
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Annedi SC, Maddaford SP, Ramnauth J, Renton P, Speed J, Rakhit S, Andrews JS, Porreca F. 3,5-Disubstituted indole derivatives as selective human neuronal nitric oxide synthase (nNOS) inhibitors. Bioorg Med Chem Lett 2012; 22:1980-4. [PMID: 22318159 DOI: 10.1016/j.bmcl.2012.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 11/18/2022]
Abstract
A series of 3,5-disubstituted indole derivatives was designed, synthesized and evaluated as inhibitors of human nitric oxide synthase (NOS). Various guanidine isosteric groups were explored at the 5-position of the indole ring, while keeping the basic amine side chain such as N-methylpiperidine ring, fixed at the 3-position of the indole ring. Compounds having 2-thiophene amidine and 2-furanyl amidine groups (7, 8, 10 and 12) showed increased activity for human neuronal NOS and good selectivity over endothelial and inducible NOS isoforms. Compound 8 was shown to reverse (10mg/kg, ip) thermal hyperalgesia in the L(5)/L(6) spinal nerve ligation (neuropathic pain) model and was devoid of any significant drug-drug interaction potential due to cytochrome P450 inhibition or cardiovascular liabilities associated with the inhibition of endothelial NOS.
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Affiliation(s)
- Subhash C Annedi
- NeurAxon Inc., 2395 Speakman Drive, Suite #1001, Mississauga, ON, Canada L5K 1B3.
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26
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Annedi SC, Ramnauth J, Maddaford SP, Renton P, Rakhit S, Mladenova G, Dove P, Silverman S, Andrews JS, Felice MD, Porreca F. Discovery of cis-N-(1-(4-(methylamino)cyclohexyl)indolin-6-yl)thiophene-2-carboximidamide: a 1,6-disubstituted indoline derivative as a highly selective inhibitor of human neuronal nitric oxide synthase (nNOS) without any cardiovascular liabilities. J Med Chem 2012; 55:943-55. [PMID: 22175766 DOI: 10.1021/jm201564u] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A series of 1,6-disubstituted indoline derivatives were synthesized and evaluated as inhibitors of human nitric oxide synthase (NOS) designed to mitigate the cardiovascular liabilities associated with previously reported tetrahydroquinoline-based selective neuronal NOS inhibitors due to higher lipophilicity ( J. Med. Chem. 2011 , 54 , 5562 - 5575 ). This new series produced similar potency and selectivity among the NOS isoforms and was devoid of any cardiovascular liabilities associated with QT prolongation due to hERG activity or endothelial NOS mediated vasoconstriction effect. The SAR studies led to the identification of cis-45, which was shown to reverse thermal hyperalgesia in vivo in the spinal nerve ligation model of neuropathic pain with excellent safety profile (off-target activities at 80 CNS related receptors/ion channels/transporters). The results presented in this report make cis-45 as an ideal tool for evaluating the potential role of selective nNOS inhibitors in CNS related disorders where excess NO produced by nNOS is thought to play a crucial role.
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Affiliation(s)
- Subhash C Annedi
- NeurAxon Inc. , 2395 Speakman Drive, Suite 1001, Mississauga, Ontario L5K 1B3, Canada
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27
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Annedi SC, Maddaford SP, Mladenova G, Ramnauth J, Rakhit S, Andrews JS, Lee DKH, Zhang D, Porreca F, Bunton D, Christie L. Discovery of N-(3-(1-methyl-1,2,3,6-tetrahydropyridin-4-yl)-1H-indol-6-yl) thiophene-2-carboximidamide as a selective inhibitor of human neuronal nitric oxide synthase (nNOS) for the treatment of pain. J Med Chem 2011; 54:7408-16. [PMID: 21923116 DOI: 10.1021/jm201063u] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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
3,6-Disubstituted indole derivatives were designed, synthesized, and evaluated as inhibitors of human nitric oxide synthase (NOS). Bulky amine containing substitution on the 3-position of the indole ring such as an azabicyclic system showed better selectivity over 5- and 6-membered cyclic amine substitutions. Compound (-)-19 showed the best selectivity for neuronal NOS over endothelial NOS (90-fold) and inducible NOS (309-fold) among the current series. Compounds 16 and (-)-19 were shown to be either inactive or very weak inhibitors of human cytochrome P450 enzymes, indicating a low potential for drug-drug interactions. Compound 16 was shown to reverse thermal hyperalgesia in vivo in the Chung model of neuropathic pain. Compound 16 was also devoid of any significant vasoconstrictive effect in human coronary arteries, associated with the inhibition of human eNOS. These results suggest that 16 may be a useful tool for evaluating the potential role of selective nNOS inhibitors in the treatment of pain such as migraine and CTTH.
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Affiliation(s)
- Subhash C Annedi
- NeurAxon Inc., 2395 Speakman Drive, Suite 1001, Mississauga, Ontario, L5K 1B3, Canada.
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Abstract
Resident interest in global health is increasing; however, a paucity of literature on competency-based curricula in global child health is available. A collaborative group including members from the University of Minnesota (UMN) Department of Pediatrics, the UMN College of Education and Human Development, and the Makerere University Department of Paediatrics and Child Health in Kampala, Uganda, developed a competency-based global child health curriculum for pediatrics residents at UMN. The group defined competencies for each of the Accreditation Council for Graduate Medical Education competency domains and developed the curriculum via six steps: (1) defining competencies specific to global child health, (2) authoring goals and objectives for each competency, (3) assigning appropriate postgraduate training levels to each competency, (4) determining intended resident groups for each competency, (5) aligning the program with the existing residency education program, and (6) developing methods to evaluate acquisition of each competency. Faculty implemented the competency-based curriculum in 2009, and the curriculum is now freely available online for adaptation and use by other residency programs. Faculty are currently introducing evaluation methods, which will allow them, for the first time, to assess a trainee's competency in global child health by the end of his or her residency. The authors believe that the development of this curriculum represents an important step forward in global health education for pediatric residents and that other residency programs, including those of nonpediatric specialties, can use the process as a model to develop global health curricula.
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Affiliation(s)
- Cynthia R Howard
- Pediatric Global Health Education Program, University of Minnesota, Minneapolis, Minnesota 55414, USA.
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De Felice M, Ossipov MH, Wang R, Dussor G, Lai J, Meng ID, Chichorro J, Andrews JS, Rakhit S, Maddaford S, Dodick D, Porreca F. Triptan-induced enhancement of neuronal nitric oxide synthase in trigeminal ganglion dural afferents underlies increased responsiveness to potential migraine triggers. Brain 2010; 133:2475-88. [PMID: 20627971 DOI: 10.1093/brain/awq159] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Migraine is a common neurological disorder often treated with triptans. Triptan overuse can lead to increased frequency of headache in some patients, a phenomenon termed medication overuse headache. Previous preclinical studies have demonstrated that repeated or sustained triptan administration for several days can elicit persistent neural adaptations in trigeminal ganglion cells innervating the dura, prominently characterized by increased labelling of neuronal profiles for calcitonin gene related peptide. Additionally, triptan administration elicited a behavioural syndrome of enhanced sensitivity to surrogate triggers of migraine that was maintained for weeks following discontinuation of drug, a phenomenon termed 'triptan-induced latent sensitization'. Here, we demonstrate that triptan administration elicits a long-lasting increase in identified rat trigeminal dural afferents labelled for neuronal nitric oxide synthase in the trigeminal ganglion. Cutaneous allodynia observed during the period of triptan administration was reversed by NXN-323, a selective inhibitor of neuronal nitric oxide synthase. Additionally, neuronal nitric oxide synthase inhibition prevented environmental stress-induced hypersensitivity in the post-triptan administration period. Co-administration of NXN-323 with sumatriptan over several days prevented the expression of allodynia and enhanced sensitivity to stress observed following latent sensitization, but not the triptan-induced increased labelling of neuronal nitric oxide synthase in dural afferents. Triptan administration thus promotes increased expression of neuronal nitric oxide synthase in dural afferents, which is critical for enhanced sensitivity to environmental stress. These data provide a biological basis for increased frequency of headache following triptans and highlight the potential clinical utility of neuronal nitric oxide synthase inhibition in preventing or treating medication overuse headache.
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Affiliation(s)
- Milena De Felice
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
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Andrews JS. Incest—Who Needs It? AUST J FORENSIC SCI 2009. [DOI: 10.1080/00450617709410447] [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: 10/20/2022]
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Affiliation(s)
- John S Andrews
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Patman J, Bhardwaj N, Ramnauth J, Annedi SC, Renton P, Maddaford SP, Rakhit S, Andrews JS. Novel 2-aminobenzothiazoles as selective neuronal nitric oxide synthase inhibitors. Bioorg Med Chem Lett 2007; 17:2540-4. [PMID: 17317165 DOI: 10.1016/j.bmcl.2007.02.011] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 02/02/2007] [Accepted: 02/06/2007] [Indexed: 11/29/2022]
Abstract
A series of substituted 2-aminobenzothiazole compounds have been synthesized and evaluated as nitric oxide synthase (NOS) inhibitors. Compound 14 shows activity in the nM range and is selective for the human neuronal NOS isoform. We have also evaluated the compounds against the rat NOS isoforms. For some of the compounds, there are significant differences in NOS inhibitory activities between the human and rat enzymes. For example, compound 10b has nM activity against the rat nNOS while low microM activity against the human nNOS.
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Affiliation(s)
- Joanne Patman
- NeurAxon Inc. Suite 318, 16-1375 Southdown Road, Mississauga, Ont., Canada L5J 2Z1
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Kapur S, Langlois X, Vinken P, Megens AAHP, De Coster R, Andrews JS. The differential effects of atypical antipsychotics on prolactin elevation are explained by their differential blood-brain disposition: a pharmacological analysis in rats. J Pharmacol Exp Ther 2002; 302:1129-34. [PMID: 12183672 DOI: 10.1124/jpet.102.035303] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [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: 11/22/2022] Open
Abstract
All atypical antipsychotics avoid extrapyramidal side-effects yet differ in their propensity to cause other side-effects, like prolactin elevation. We proposed that the atypical antipsychotics with a propensity for prolactin elevation would show a higher pituitary versus striatal D2 receptor occupancy. To investigate this hypothesis, we tested four atypical antipsychotics, two that are commonly associated with prolactin elevation (amisulpride and risperidone) and two that are less frequently associated (quetiapine and olanzapine). In particular, we calculated their ED(50) values to increase plasma prolactin and block peripheral pituitary D2 receptors to their ED(50) values to antagonize apomorphine-induced stereotypy and occupy central striatal D2 receptors. All antipsychotics dose dependently increased prolactin levels and antagonized apomorphine-induced stereotypy. However, the central to peripheral potency (ED(50) for apomorphine antagonism to ED(50) for prolactin elevation) differed remarkably across these drugs: amisulpride (21764), risperidone (14), quetiapine (10), and olanzapine (1.7). Compounds displaying a higher peripheral potency brought about higher prolactin levels for a given level of functional central antagonism. This dissociation between central and peripheral effects was explained by the differential occupancy of D2 receptors in the striatum versus in the pituitary [ratio of striatal/pituitary ED(50) values (milligram per kilogram) for D2 occupancy): amisulpride (17/0.026 = 654), risperidone (0.89/0.081 = 14), quetiapine (24/4.1 = 6), olanzapine (0.30/0.43 = 0.7). These results indicate that dissociation between central and peripheral D2 receptor occupancy is a major determinant of the degree of prolactin elevation observed at therapeutic doses.
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Affiliation(s)
- S Kapur
- Centre for Addiction and Mental Health, Clarke Division, 250 College Street, Toronto, Ontario, Canada M5R 1T8.
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Abstract
BACKGROUND Acne is a very common problem with significant physical and psychological morbidity. The evidence basis for its treatment had not been systematically reviewed. Therefore, we performed an evidence review to provide researchers a basis for further studies, and to provide clinicians the background needed to interpret current and future clinical studies. OBJECTIVE We summarize the methodologic state of the acne literature in patients with acne who do not have complicating co-morbidities. METHODS This was an expert-advised literature synthesis. We used a structured literature search for English-language controlled trials in Cochrane CENTRAL, MEDLINE, OLDMEDLINE, HSTAT, CINAHL, and PsychInfo. Results underwent a structured data abstraction process, with review by at least 2 reviewers. RESULTS Out of 1588 unique articles, 250 articles (274 controlled trials) over the past 50 years were reviewed: 57 (21%) trials had at least one major weakness and no strengths; 125 (47%) trials had at least one major strength and at least one major weakness; 48 (18%) trials had at least one major strength, and no major weaknesses. The remaining 16 (6%) were of intermediate quality or did not provide enough information to make a determination. One fourth of studies did not report patient age; one fourth did not report on patient gender. Only 8% mentioned patient race; only 2% mentioned skin type; 0.4% mentioned diet; none scored sexual maturity or insurance status. There were 1237 outcomes. There were more than 25 methods of assessing acne severity and more than 19 methods for counting lesions. There were only two trials that formally assessed psychological outcomes. More than 140 treatments were tested in 251 comparisons. CONCLUSION Ranging over 50 years of research, the acne literature evidences great heterogeneity at all levels: patient characteristics, acne severity, outcome assessments, treatments, and comparisons. A list of methodologic recommendations is provided.
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Affiliation(s)
- Harold P Lehmann
- Department of Pediatrics, Johns Hopkins School of Medicine and Bloomberg School of Public Health, USA
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Mehta S, Andrews JS, Johnston BD, Pinto BM. Novel Hetero-analogs of Methyl Maltoside Containing Sulfur and Selenium as Potential Glycosidase Inhibitors. J Am Chem Soc 2002. [DOI: 10.1021/ja00083a052] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Corwin AH, Andrews JS. Studies in the Pyrrole Series. III. The Relation of Tripyrrylmethane Cleavage to Methene Synthesis1,2. J Am Chem Soc 2002. [DOI: 10.1021/ja01289a053] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andrews JS, Weimar T, Frandsen TP, Svensson B, Pinto BM. Novel Disaccharides Containing Sulfur in the Ring and Nitrogen in the Interglycosidic Linkage. Conformation of Methyl 5'-Thio-4-N-.alpha.-Maltoside Bound to Glucoamylase and Its Activity as a Competitive Inhibitor. J Am Chem Soc 2002. [DOI: 10.1021/ja00149a002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mehta S, Andrews JS, Svensson B, Pinto BM. Synthesis and Enzymic Activity of Novel Glycosidase Inhibitors Containing Sulfur and Selenium. J Am Chem Soc 2002. [DOI: 10.1021/ja00144a001] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gielen AC, McDonald EM, Wilson MEH, Hwang WT, Serwint JR, Andrews JS, Wang MC. Effects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial. Arch Pediatr Adolesc Med 2002; 156:33-40. [PMID: 11772188 DOI: 10.1001/archpedi.156.1.33] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To present the results of an intervention trial to enhance parents' home-safety practices through pediatric safety counseling, home visits, and an on-site children's safety center where parents receive personalized education and can purchase reduced-cost products. DESIGN Pediatricians were randomized to a standard- or an enhanced-intervention group. Parents of their patients were enrolled when the patient was 6 months or younger and observed until 12 to 18 months of age. SETTING A hospital-based pediatric resident continuity clinic that serves families living in low-income, inner-city neighborhoods. PARTICIPANTS First- and second-year pediatric residents and their patient-parent dyads. INTERVENTIONS Parents in the standard-intervention group received safety counseling and referral to the children's safety center from their pediatrician. Parents in the enhanced-intervention group received the standard services plus a home-safety visit by a community health worker. OUTCOMES Home observers assessed the following safety practices: reduction of hot-water temperature, poison storage, and presence of smoke alarms, safety gates for stairs, and ipecac syrup. RESULTS The prevalence of safety practices ranged from 11% of parents who stored poisons safely to 82% who had a working smoke alarm. No significant differences in safety practices were found between study groups. However, families who visited the children's safety center compared with those who did not had a significantly greater number of safety practices (34% vs 17% had > or 3). CONCLUSIONS Home visiting was not effective in improving parents' safety practices. Counseling coupled with convenient access to reduced-cost products appears to be an effective strategy for promoting children's home safety.
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Affiliation(s)
- Andrea Carlson Gielen
- Center for Injury Research and Policy, Johns Hopkins University, Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA.
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Andrews JS. Animal parasitology in the United States Department of Agriculture: 1886-1984. J Nal Assoc 2001; 11:113-66. [PMID: 11617416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Lehmann HP, Andrews JS, Robinson KA, Holloway VL, Goodman SN. Management of acne. Evid Rep Technol Assess (Summ) 2001:1-3. [PMID: 11898669 PMCID: PMC4781220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Gielen AC, Wilson ME, McDonald EM, Serwint JR, Andrews JS, Hwang WT, Wang MC. Randomized trial of enhanced anticipatory guidance for injury prevention. Arch Pediatr Adolesc Med 2001; 155:42-9. [PMID: 11177061 DOI: 10.1001/archpedi.155.1.42] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To develop and evaluate an injury prevention anticipatory guidance training program for pediatric residents. DESIGN Thirty-one residents were randomly assigned to an intervention or control group. Both groups attended a 1-hour seminar about injury prevention and the American Academy of Pediatrics TIPP (The Injury Prevention Program) materials. The intervention group also received 5 hours of experiential instruction on injury prevention content and counseling skills (SAFE Counseling Framework). Families with infants from birth to age 6 months were enrolled in the study (N = 196); they were followed up until the child was aged 12 to 18 months. Data were collected by means of baseline and follow-up interviews, audiotapes of medical visits, parent exit surveys, and home observations. SETTING A hospital-based continuity clinic that serves families living in low-income, inner-city neighborhoods. OUTCOMES Physician counseling and parent satisfaction, knowledge, beliefs, and behaviors. RESULTS Parents seen by physicians in the intervention group received significantly more injury prevention counseling for 5 of the 6 safety practices, and they were significantly more satisfied with the help their physicians provided on safety topics. They were no less satisfied with their physicians' counseling on other anticipatory guidance topics. Parents' knowledge, beliefs, and home safety behaviors did not differ between the 2 groups. CONCLUSIONS The frequency and impact of pediatric counseling can be enhanced by experiential training that targets specific injury hazards. Because low-income families face many barriers to carrying out the recommended safety practices, supplemental strategies are needed to ensure safer homes.
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Affiliation(s)
- A C Gielen
- Center for Injury Research and Policy, Johns Hopkins University, School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND Although some children with asthma experience multiple admissions, asthma is considered a preventable cause of hospitalization. OBJECTIVE To assess whether components of medical histories, ambulatory care prior to hospitalization, or ambulatory care after discharge are associated with repeated hospitalizations for children admitted with asthma. DESIGN Nested case-control study of a cohort of children hospitalized for asthma, comparing those who were rehospitalized within 1 year with those not rehospitalized. SETTING Urban pediatric primary care clinic. PARTICIPANTS AND METHODS Subjects were 119 children, aged 0 to 14 years, who had an inpatient admission with a diagnosis of asthma between July 1, 1993, and June 30, 1995 (index hospitalization). Data sources included medical charts, computerized patient records, and administrative data. Use of health care services was compared among children who were rehospitalized within 1 year of the index admission and those who were not. MAIN OUTCOME MEASURE Repeated hospitalizations. RESULTS The proportions of children who received general pediatric, allergy, or pulmonary care in the year prior to the index hospitalization were 86%, 7%, and 8%, respectively. By report, half of all children did not receive prescribed therapies, more than half were exposed to cigarette smoke at home, and one fourth were not up-to-date with immunizations at the time of admission. Thirty-five of the 119 children hospitalized with asthma were subsequently readmitted with asthma within 1 year of the index hospitalization. Children readmitted did not differ from those with a single admission in terms of the above characteristics. However, significantly more children subsequently readmitted had a pulmonary consultation during the index admission (23% vs 4%; P = .001) or in the year following discharge (37% vs 12%; P = .002). In addition, children readmitted were more likely to have other chronic conditions (69% vs 49%; P= .048). CONCLUSION Among low-income urban children, readmission for asthma is not associated with receipt of prescribed therapies or pediatric care.
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Affiliation(s)
- C S Minkovitz
- Department of Population and Family Health Sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA
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Drinkenburg WH, Keith AB, Sahgal A, Andrews JS. Haloperidol-induced within-session response decrement patterns and catalepsy in rats: behavioural dissociation. Behav Pharmacol 1999; 10:105-11. [PMID: 10780307 DOI: 10.1097/00008877-199902000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/26/2022]
Abstract
The typical antipsychotic haloperidol is known to induce extra-pyramidal side-effects (EPS). Catalepsy in rats is generally regarded as a valid model for detecting the EPS liability of compounds in humans. Together with its antipsychotic and cataleptogenic actions, haloperidol causes an attenuation of instrumental responding which becomes larger in the course of a session: a within-session response decrement. The present study compared the time-course of haloperidol-induced catalepsy, measured by a bar test, to the haloperidol-induced within-session response decrements, measured by operant behaviour under a fixed ratio 10 schedule of reinforcement. Rats were trained to press a lever on a Fixed Ratio 10 schedule of food reinforcement during sessions of 15 min. When responding was stable, saline or haloperidol in 0.03 mg/kg, 0.1 mg/kg, or 0.3 mg/kg was administered intra-peritoneally either 30, 90 or 180 min prior to behavioural testing. The number of lever presses, food tray visits and latency to press the lever and to visit the food tray were analysed in five successive blocks of 3 min. Catalepsy was tested 30, 60, 90, 120, and 180 min. after injection, by placing a rat with its forepaws on a horizontal bar. The latency to remove both forepaws from the bar was scored. Within-session response decrements were present at 0.1 mg/kg and at 0.3 mg/kg, from 30 min after administration onward. At these doses, latency to press the lever was increased after 30 and 90 min, but not significantly after 180 min. Latency to visit the tray was affected only after 30 min, at 0.3 mg/kg. Haloperidol induced a dose-dependent increase in catalepsy from 60 min onwards, with maximal effect after 120 min. A dissociation between the time-course of occurrence of within-session response decrement and the cataleptogenic action of haloperidol, as well as between the latter and both latency measures, was found. Consequently, the present data suggest that within-session response decrements are not obviously caused by catalepsy-related impairments.
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Affiliation(s)
- W H Drinkenburg
- MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle upon Tyne, UK.
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