bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Longitudinal Study of Serum Brain-Derived Neurotrophic Factor Levels in First-Episode Schizophrenia
Authors: Yee Jie Yin , Lee Tih-Shih , Lee Jimmy 
Published: November 2019

Abstract

Background
Biomarkers identified for psychosis might allow for early diagnosis, more accurate prognosis, and tailored individualized interventions. Brain-derived neurotrophic factor (BDNF) is suggested to be a likely candidate biomarker for the diagnosis and treatment evaluation in psychosis. The aims of present study were to examine the levels of serum BDNF in both patients with first-episode psychosis (FEP) and in healthy controls for a year, and to investigate the association between BDNF with symptom severity and remission status.

Methods
A sample of 31 healthy controls and 29 patients with FEP were included in this study. Diagnoses were ascertained on the Structured Clinical Interview for DSM-IV-TR. Symptom severity was assessed on the Positive and Negative Syndrome Scale. Serum levels of BDNF were measured using enzyme-linked immunosorbent assay method at recruitment and at 3-, 6-, and 12-month time points.

Results
Serum BDNF levels in both groups did not differ significantly over time. Baseline BDNF levels in patients with FEP did not correlate with symptom severity and neither baseline BDNF level nor its relative change at 3-month predicted remission status at 6- and 12-month follow-up visits. Of note, we observe similar fluctuations in serum BDNF levels in both patients and healthy controls over the 12-month period.

Conclusions
Findings from our study did not support a role for serum BDNF as a biomarker for patients with FEP. Because of the polygenic nature of psychosis, we recommend a comprehensive multimarker profile consisting of markers from representative components of mediated neuronal nutrition, neuroimmunology, and neurologic functional deficit to allow for better predictive power.
Effects of Pharmacogenetic Screening for CYP2D6 Among Elderly Starting Therapy With Nortriptyline or Venlafaxine
Authors: van der Schans Jurjen , Hak Eelko , Postma Maarten , Breuning Laura , Brouwers Jacobus R.B.J. , Ditters Kaspar , Jansen Paul A.F. , Kok Rob M. , Maring Jan G. , van Marum Rob , Mulder Hans , Nanninga Jaap , Oude Voshaar Richard C. , Risselada Arne J. , Vleugel Liesbeth , Stek Max , van Schaik Ron H.N. , Berm Elizabeth J.J. , Wilffert Bob 
Published: November 2019

Abstract

Purpose/Background
The duration of untreated depression is a predictor for poor future prognosis, making rapid dose finding essential. Genetic variation of the CYP2D6 isoenzyme can influence the optimal dosage needed for individual patients. The aim of this study was to determine the effectiveness of CYP2D6 pharmacogenetic screening to accelerate drug dosing in older patients with depression initiating nortriptyline or venlafaxine.

Methods/Procedures
In this randomized controlled trial, patients were randomly allocated to one of the study arms. In the intervention arm (DG-I), the specific genotype accompanied by a standardized dosing recommendation based on the patients' genotype and the prescribed drug was directly communicated to the physician of the participant. In both the deviating genotype control arm (DG-C) and the nonrandomized control arm, the physician of the participants was not informed about the genotype and the associated dosing advise. The primary outcome was the time needed to reach adequate drug levels: (1) blood levels within the therapeutic range and (2) no dose adjustments within the previous 3 weeks.

Findings/Results
No significant difference was observed in mean time to reach adequate dose or time to adequate dose between DG-I and DG-C. Compared with the nonrandomized control arm group, adequate drug levels were reached significantly faster in the DG-I group (log-rank test; P = 0.004), and there was a similar nonsignificant trend for the DG-C group (log-rank test; P = 0.087).

Implications/Conclusions
The results of this study do not support pharmacogenetic CYP2D6 screening to accelerate dose adjustment for nortriptyline and venlafaxine in older patients with depression.
Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia
Authors: Devrimci-Ozguven Halise , Atmaca Murad , Baran Zeynep , Cengisiz Cengiz , Çinar Cem , Erol Atila , Genç Yasin , Karadağ Hasan , Karakülah Kamuran , Karasu Umut , Kaya Mehmet Cemal , Kizil Emre , Özcan Halil , Tiryaki Ahmet , Üçok Alp , Varlik Cenk , Yazar Sila Menekşe , Yildiz Mesut 
Published: November 2019

Abstract

Purpose
The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data.

Methods
This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded.

Results
Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less.

Conclusions
Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.
Pharmacokinetic-Pharmacodynamic Characterization of Relapse Risk for Paliperidone Palmitate 1-Month and 3-Month Formulations
Authors: Russu Alberto , Savitz Adam , Mathews Maju , Gopal Srihari , Feng Yu , Samtani Mahesh N. 
Published: November 2019

Abstract

Background
Pharmacokinetic-pharmacodynamic (PK/PD) models were developed to describe the relationship between the time course of paliperidone plasma concentrations and the risk of relapse of schizophrenia symptoms following administration of paliperidone palmitate 1-month (PP1M) and 3-month (PP3M) long-acting injectables, and to identify relevant covariates for relapse and dropout events.

Methods
Patient data from two global phase 3, relapse prevention studies comparing PP3M to placebo (study A) and PP3M to PP1M (study B) were analyzed. Dropout and relapse data were assessed using survival analysis as two separate single time-to-event models. Baseline covariates included age, sex, race/country, duration of illness, previous hospitalizations, prior use of long-acting injectables and use of multiple (≥2) antipsychotics at screening.

Results
The PK/PD analysis data set included 305 patients who were randomized to receive PP3M or placebo in the double-blind phase of study A and 1002 patients randomized to receive PP3M or PP1M in the double-blind phase of study B. Risk of relapse decreased with increasing paliperidone concentrations for both PP1M and PP3M, while it appeared to increase in patients with higher number of previous hospitalizations and/or with higher prerandomization (trough) paliperidone concentration (study A), and in patients on concomitant benzodiazepine medication and/or at Japan centers (study B). These findings are reflective of different illness severity in the population and of differences in medical practice for Japanese patients. In model-based simulations, PP3M and PP1M displayed similar relapse rates over time.

Conclusions
This PK/PD analysis confirmed that PP1M and PP3M provide comparable efficacy in terms of relapse prevention, and that PP3M is superior to placebo. The PK/PD models presented here may as well be applied to studies with similar designs as either study A or B.
Relationship of Direct-to-Consumer Advertising to Efficiency of Care, Quality of Care, and Health Outcomes
Authors: Filipova Anna A. 
Published: November 2019

ABSTRACT

Background:
Direct-to-consumer advertising (DTCA) is effective in promoting pharmaceutical products to consumers and may pose a challenge to providers in the delivery of care. This study examined advanced practice nurse prescriber (APNP) general views of DTCA and tested the effects of DTCA discussion between the patient and APNP in an office visit on efficiency of care, quality of care, and health outcomes.

Methods:
A cross-sectional design was used to survey 1,163 APNPs in a single US Midwestern state. The final sample consisted of 316 participants (27.17%). Pearson's chi-squared and multinomial logistic regression analyses tested DTCA effects.

Results:
Direct-to-consumer advertising disadvantages were increased costs of drugs (80%) and misled patients (75%). Direct-to-consumer advertising benefits included a balanced presentation of risks and benefits (60%) and patients getting treatments (51%). Direct-to-consumer advertising discussion was viewed as worsening time efficiency of visit (53%). Worsened efficiency was associated with worsened nurse–patient relationship. Direct-to-consumer advertising discussion had no effect on quality of care (86%) and health outcomes (89%). Worsened quality was related to inappropriate clinical requests and challenged prescriptive authority among other factors. The nurse doing what the patient wanted was related to worsened health outcomes.

Conclusion:
The findings suggest training initiatives to maximize DTCA benefits in health care delivery.
Physician Practices in Against Medical Advice Discharges
Authors: Tummalapalli Sri Lekha , Chang Brian A. , Goodlev Eric R. 
Published: November 2019

ABSTRACT

Background:
Patients discharged against medical advice (AMA) have disproportionately high health care costs and increased morbidity, mortality, and hospital readmissions. Although patient risk factors for discharge AMA are known, there are little data regarding physician discharge practices surrounding AMA discharges.

Methods:
We performed a cross-sectional analysis of patients discharged AMA from a large, urban, academic medical center. Our study predictors included patient demographics and admission characteristics: primary service team, time of discharge, documentation of anticipated AMA discharge, and length of stay. The primary outcomes were physician discharge practices including a scheduled follow-up appointment, documentation of informed consent, documentation of a risk/benefit discussion, and notification of the attending physician. Our coprimary outcome was the incidence of 30-day hospital readmission.

Results:
Among AMA discharges, 33% had follow-up appointments scheduled upon discharge. There was documentation of a risk/benefit discussion (69%), informed consent (63%), and notification of the attending physician (72%) in most discharges. Physician discharge practices were not associated with 30-day hospital readmission.

Conclusions:
Adherence to discharge best practices in AMA discharges was inconsistent and suboptimal, particularly for scheduling follow-up appointments, but was not associated with hospital readmission. Our results highlight the difficulty in facilitating safe transitions of care for patients discharged AMA.
Distributions and Reference Ranges for Automated Pupillometer Values in Neurocritical Care Patients
Authors: Lussier Bethany L. , Stutzman Sonja E. , Atem Folefac , Venkatachalam Aardhra M. , Perera Anjali C. , Barnes Arianna , Aiyagari Venkatesh , Olson DaiWai M. 
Published: November 2019

ABSTRACTBACKGROUNDAutomated pupillometry is becoming widely accepted as an objective measure of pupillary function, especially in neurocritical care units. Normative reference values and thresholds to denote a significant change are necessary for integrating automated pupillometry into practice.OBJECTIVEProviding point estimates of normal ranges for pupillometry data will help clinicians intuit meaning from these data that will drive clinical interventions.METHODSThis study used a planned descriptive analysis using data from a multicenter registry including automated pupillometry assessments in 2140 subjects from 3 US hospitals collected during a 3-year period.RESULTSWe provide a comprehensive list of admission pupillometry data. Our data demonstrate significant differences in pupillary values for Neurological Pupil Index, latency, and constriction velocity when stratified by age, sex, or severity of illness defined by the Glasgow Coma Scale score.CONCLUSIONThis study provides a greater understanding of expected distributions for automated pupillometry values in a wide range of neurocritical care populations.
Impacts of Fatigue, Stress, and Perceived Health Status on Women With Rheumatic Diseases: A Comparison Study
Authors: HUNG Hsuan-Man , CHEN Ming-Fu , CHEN Chung-Hey 
Published: November 2019

ABSTRACT

Background
Rheumatic conditions, which increase in prevalence as populations age, are a growing public health problem that disproportionately affects women. Understanding the influences of rheumatic diseases (RDs) on fatigue, stress, and perceived health status is deemed important to the improvement of physical and mental health for women with RDs.

Purpose
This study was designed to compare the fatigue, stress, and perceived physical and mental health status of women with RDs (RD group) with those of peers who did not have chronic illnesses (comparison group).

Methods
A cross-sectional, purposive sample and comparative design was used. Four hundred forty-three women with a mean age of 46.2 years participated in this study. Those with physician-diagnosed RDs (n = 212) were enrolled in the RD group, and those without chronic disease were enrolled in the comparison group (n = 231). Measures used included a demographic datasheet, Fatigue Severity Scale, Perceived Stress Scale, and Short Form-12 Items Health Survey. Analysis of covariance was used to examine the intergroup differences for major variables based on demographic covariates.

Results
The RD group reported significantly more fatigue and stress than the comparison group. Moreover, the RD group reported significantly poorer perceived physical health status, significantly poorer physical functioning and general health, and greater bodily pain compared with the comparison group. Conversely, the RD group reported significantly better perceived mental health status, significantly lower vitality, and better role emotional status than the comparison group.

Conclusions/Implications for Practice
The findings support the theory that RDs have a negative impact on perceived stress and fatigue in women. Physical function, bodily pain, and general health may be the most significantly affected domains of perceived physical health in women with RDs. Of note, with the exception of the vitality subscale, RDs did not adversely affect the perceived mental health of participants with RD in this study. Healthcare professionals should cooperate with clinical rheumatologists, psychologists, and physiotherapists to provide comprehensive care that includes long-term education to help patients with RD self-manage stress, restore vitality, relieve pain, and increase physical function.
Validation of the Supportive Care Needs Survey Screening Tool Chinese Version for Patients With Head and Neck Cancer in Taiwan
Authors: HU Chan-Chuan , YOU Kai-Lin , TSAI Li-Yun , FANG Yuan-Yuan , JHANG Sin-Yuan , LOU Pei-Jen , WANG Cheng-Ping , KO Jenq-Yuh , LEE Yun-Hsiang , LAI Yeur-Hur 
Published: November 2019

ABSTRACT

Background
The increasing number of cancer survivors and the trend of shifting cancer treatments into outpatient clinics have increased rapidly the supportive care needs of patients with cancer. However, no brief assessment tool is available to screen for these needs.

Purpose
In this study, we aimed to (a) translate and develop a nine-item Chinese version of the Supportive Care Needs Survey Screening Tool (SCNS-ST9-C) and (b) examine the psychometric properties of this tool in a sample of patients with head and neck cancer (HNC) in Taiwan.

Methods
In this two-phase instrument validation study, the SCNS-ST9-C was translated and evaluated for content, face validity, and feasibility in Phase I and was examined for internal consistency reliability and construct validity (including factor structure and theoretically supported correlations) on a sample of patients with HNC in Phase II.

Results
In Phase I, the SCNS-ST9-C was translated and developed by three bilingual doctoral-prepared nurse researchers (Chinese and English). A standardized score system ranging from 0 to 100 was built, with higher scores indicating higher unmet supportive care needs. Good content and face validity were confirmed by five cancer care experts and 20 patients with HNC, respectively. In Phase II, 116 subjects were recruited. A clear four-factor structure, which incorporated one of the original five dimensions (sexuality care needs, with one item) into the dimension of psychological and emotional care needs, was identified using exploratory factor analysis. Good internal consistency reliability for the overall SCNS-ST9-C was supported by a Cronbach's α of .75 and its four subscales (domains). Good construct validity was also confirmed by the theoretically supported correlations. Better performance status and longer time since treatment completion correlated negatively with the SCNS-ST9-C (i.e., lower unmet care needs), whereas higher distress (anxiety, depression, and symptoms) correlated positively with the SCNS-ST9-C (i.e., greater unmet care needs). Female patients reported higher overall unmet care needs and psychological and emotional care needs and higher scores on the care and support needs subscale than male patients.

Conclusions
The SCNS-ST9-C is a brief, low-burden, and psychometrically valid instrument that may be applied in ethnically Chinese settings. This tool takes 1–2 minutes to complete. Further testing of the psychometrics of this instrument in different cancer populations is recommended.
Oral Dysfunction in Patients With Head and Neck Cancer: A Systematic Review
Authors: CHEN Shu-Ching 
Published: November 2019

ABSTRACT

Background:
Head and neck cancers (HNCs) and their treatment may cause oral function impairment.

Purpose:
This study was designed to identify oral dysfunction in patients receiving treatment for HNCs using a systematic review.

Methods:
The PubMed, Embase, and CINAHL databases were searched for studies on oral function impairment in patients receiving treatment for HNCs published between January 2014 and May 2019. Only descriptive, correlational, and interventional quantitative studies that included patients receiving treatment for HNCs who presented with oral dysfunction, were published in English during the aforementioned time frame, and were accessible in full-text versions were selected.

Results:
Twenty-eight studies (13 cross-sectional, two longitudinal, 12 randomized controlled trial, and one retrospective chart review) fulfilled the inclusion criteria. Oral mucositis, dysphagia, xerostomia, trismus, and chewing and speech problems were the most common oral dysfunctions. Age, cancer stage, tumor location, treatment modalities, treatment status, treatment dose, and pretreatment oral function were factors associated with oral dysfunction. Although individual interventions were shown to improve oral dysfunction, the related evidence was inconclusive.

Conclusions/Implications for Practice:
Primary HNCs and their treatment significantly deteriorate oral function. A holistic and interdisciplinary approach may maximize oral function.
Completion of an Individualized Learning Plan for Otology-Related Milestone Subcompetencies Leads to Improved Otology Section Otolaryngology Training Exam Scores
Authors: Pennock Michael , Svrakic Maja , Bent John P. 
Published: November 2019

Objective:
To examine the relationships among self-assessment of knowledge in otology via an individualized learning plan (ILP), otology milestone achievement rate, and otolaryngology training exam (OTE) otology scores.

Study Design:
Prospective study.

Setting:
One otolaryngology residency covering a tertiary care facility, trauma and hospital center, outpatient ambulatory surgery center, and outpatient clinics.

Participants:
Twenty otolaryngology residents, four from each class.

Methods:
Residents identified four milestones from otology-related sub-competencies to achieve in a 3-month rotation via an ILP. During the same rotation, the residents sat for the OTE, and their overall and otology scores were analyzed.

Main Outcome Measures:
Completion of an ILP before and at the end of the rotation, self-reported achievement of otology milestones, and OTE score components including total percent correct, scaled score, group stanine, national stanine, and residency group weighted scores.

Results:
Group stanine OTE otology scores were higher for those residents who completed pre- and post-rotation ILPs compared with those who did not, 4.0 (±0.348) versus 2.75 (±0.453), respectively (p = 0.04). Residents who self-reported achieving all four otology milestones had significantly higher otology group stanine scores than the residents who achieved less, 4.1 (±0.348) versus 2.9 ± 0.433, respectively (p = 0.045). Residents who performed well in their PGY program cohort on the otology OTE 1 year were less inclined to complete an ILP for otology in the subsequent year (Pearson correlation –0.528, p = 0.035).

Conclusion:
In the otology subspecialty, residents who completed ILPs scored better on OTE examinations independent of resident class. Consequently, programs may find ILPs useful in other otolaryngology subspecialties and across residencies.
Reducing Postoperative Call Volume Through Verbal Preoperative Education
Authors: Chern Alexander , Haynes David S. , Bennett Marc L. 
Published: November 2019

Objective:
To improve patient satisfaction and understanding of what to expect after chronic ear surgery and reduce call volume to an otology clinic at an academic tertiary referral center.

Study Design:
Quality improvement initiative.

Setting:
A single-academic tertiary referral center.

Patients:
One hundred and ten patients who underwent chronic ear surgery in March to May 2018.

Intervention:
Preoperative counseling over the phone 1 week before surgery.

Main Outcome Measures:
Patient call volume to the clinic within a 2-week postoperative window, patient understanding, and satisfaction of perioperative course.

Results:
There was a significant increase in patient satisfaction (10.1% increase, 9.8 intervention vs. 8.9 no intervention, p = 0.0032) and in patient understanding of what to expect after surgery (6.7% increase, 9.5 intervention vs. 8.9 no intervention, p = 0.0275). There was a significant decrease in mean number of calls per patient to the clinic (57.6% decrease, 0.31 intervention vs. 0.72 no intervention, p = 0.0105) and in percentage of patients who made any number of calls to the clinic (20% intervention vs. 46%, no intervention, p = 0.00438).

Conclusions:
Verbal preoperative counseling over the phone was effective in significantly reducing unnecessary call volume to the clinic and in improving patient satisfaction and overall understanding of what to expect after surgery.