2
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9303
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Undereducation is afoot: Assessing the lack of acral lentiginous melanoma educational materials for skin of color
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Vissy M Elad
Trevena Anton
Natalie C Ganios
Vito W Rebecca
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Pigment Cell & Melanoma Research
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2023 April 25
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Acral lentiginous melanoma (ALM) is a subtype of cutaneous melanoma notorious for poor outcomes that disproportionately affect individuals with skin of color (e.g., African-, Hispanic-, Asian-descent) when compared to mortality rates among non-Hispanic White populations. There are several societal factors that contribute to racial disparities in ALM, including a lack of representative educational material in the context of patient education and medical instruction. This gap in representative information for the US population includes risk of disease, patterns of incidence, and differences in disease presentation in skin of color. The atypical presentation of ALM on acral volar skin sites makes early detection challenging and necessitates an increased index of suspicion on the part of physicians and patients alike. Studies underscoring the importance of early detection in reducing mortality risk make the availability of adequate representative educational materials indispensable.
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doi: 10.1111/pcmr.13090. Online ahead of print
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English
2023
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Intracellular Recordings Reveal Integrative Function Of The Basolateral Amygdala In Acoustic Communication
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Sergiy Voytenko
Sharad Shanbhag
Jeffrey Wenstrup
Alexander Galazyuk
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Journal of Neurophysiology
Date
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2023 Apr 26
Description
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The amygdala, a brain center of emotional expression, contributes to appropriate behavior responses during acoustic communication. In support of that role, the basolateral amygdala (BLA) analyzes the meaning of vocalizations through integration of multiple acoustic inputs with information from other senses and an animal's internal state. The mechanisms underlying this integration are poorly understood. This study focuses on the integration of vocalization-related inputs to the BLA from auditory centers during this processing. We utilized intracellular recordings of BLA neurons in unanesthetized big brown bats that relies heavily on a complex vocal repertoire during social interactions. Postsynaptic and spiking responses of BLA neurons were recorded to three vocal sequences that are closely related to distinct behaviors (appeasement, low-level aggression, and high-level aggression) and have difference emotional valence. Our novel findings are that most BLA neurons showed postsynaptic responses to one or more vocalizations (31 of 46) but that many fewer neurons showed spiking responses (8 of 46). The spiking responses were more selective than PSP responses. Further, vocal stimuli associated with either positive or negative valence were similarly effective in eliciting EPSPs, IPSPs, and spiking responses. This indicates that BLA neurons process both positive- and negative-valence vocal stimuli. The greater selectivity of spiking responses than PSP responses suggests an integrative role for processing within the BLA to enhance response specificity in acoustic communication.
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Voytenko, S., Shanbhag, S., Wenstrup, J., & Galazyuk, A. (2023). Intracellular Recordings Reveal Integrative Function Of The Basolateral Amygdala In Acoustic Communication. Journal of neurophysiology, 10.1152/jn.00103.2023. Advance online publication. https://doi.org/10.1152/jn.00103.2023
2023
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Journal of Medical Sciences at NEOMED
Volume 2, Issue 1, May 2023
Lumateperone in the Treatment of Schizophrenia: A Review
Gabrielle T. Robinson, BS1 and Altaf S. Darvesh, MPharm, PhD2,3*
1.
Basic and Translational Biomedicine Program, College of Graduate Studies, Northeast Ohio Medical
University, Rootstown, OH 44272
2.
Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown,
OH 44272
3.
Department of Psychiatry, College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272
* Corresponding Author
ABSTRACT
Schizophrenia is a devastating mental illness that afflicts about 1% of the world’s population. This illness
distorts a person’s perception of reality and consists of positive symptoms such as hallucinations and
delusions, negative symptoms such as inattention and withdrawal, and cognitive deficits. Antipsychotic
drugs are primarily used for the pharmacotherapy of schizophrenia. In this article, we provide a succinct
review of a recently approved novel antipsychotic, lumateperone. We present an overview and history of
schizophrenia, its symptoms, epidemiology, etiology, and pathophysiology. The classification of
antipsychotic agents as first and second-generation based on their receptor affinity is discussed. The
review focuses on describing the background, development, receptor pharmacology, mechanism of action,
pharmacokinetics, clinical trials, adverse effects, therapeutic uses, and future prospects of lumateperone.
Keywords: antipsychotic, atypical, lumateperone, schizophrenia, 5-HT2A serotonin receptor
INTRODUCTION
created the term ‘schizophrenia’ to replace the term
‘dementia precox’.4,5
Schizophrenia symptoms are primarily
classified as positive and negative in nature. Positive
symptoms, primarily experienced during a psychotic
episode, include delusions, hallucinations, and
disorganized thoughts, speech, and behavior. Negative
symptoms, which are deficits in normal emotional
response, are anhedonia (inability to experience
pleasure), alogia (poverty of speech or thought),
avolition (inability to initiate and persist in goal
directed activities), apathy (lack of interest, enthusiasm,
or concern), blunted affect, and social withdrawal.
Patients with schizophrenia also show cognitive deficits
such as impaired working memory, decreased verbal
fluency, and decreased abilities in reasoning and
problem solving.3,6
Although the etiology of schizophrenia is
unclear, several risk factors have been implicated in the
pathogenesis of this chronic debilitating mental illness.
Schizophrenia is classified as a neurodevelopmental
disorder with no known precise cause. Schizophrenia is
thought to develop from complex gene-environment
interactions. Environmental risk factors such as
Schizophrenia
Schizophrenia, a severe mental disorder of
unknown etiology, afflicts about 1% of the global
population.1 In 2019, the World Health Organization
reported over 20 million cases of schizophrenia
globally.2 The Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5) currently
defines schizophrenia as the presence of two or more of
the following symptoms: delusions, hallucinations,
disorganized speech, grossly disorganized or catatonic
behavior, and diminished emotional expression with the
symptoms being present for a significant portion of
time during a 1-month period. At least one of these
symptoms must be delusions, hallucinations, or
disorganized speech.3 Schizophrenia has a history,
stemming back as early as the 19th century when the
French psychiatrist, Bénédict Augustin Morel, first
coined the term ‘démence précoce’. This term would
later evolve into the term ‘dementia precox’ by the
renowned German psychiatrist Emil Kraepelin. It was
in 1908 that the Swiss psychiatrist, Eugen Bleuler,
1
�Robinson & Darvesh
JMS, May 2023—Volume 2, Issue 1
childhood trauma, stress, pregnancy complications,
nutritional deficiencies; genetic and hereditary factors
and family history; as well as structural abnormalities
such as hypofrontality (decreased blood flow in the
prefrontal cortex) have all been implicated in the
development of schizophrenia.7,8
The pathophysiology of schizophrenia is
extremely complex, and there is no single theory that
can explain the pathogenesis of this mental illness.9
Studies have found significant anatomical alternations
in several brain structures of high-risk youth. It is
hypothesized that abnormal neuronal pruning of
neurons, altered communication, and decreased
neuronal connectivity, contribute to the development of
schizophrenia.12,13
Genetic factors in schizophrenia
The role of genetic contribution and
heritability in the development of schizophrenia has
been widely studied. First-degree relatives of patients
with schizophrenia have a 10% risk of developing the
disease. This risk increases to 40% when both parents
have schizophrenia. About 40% identical twins of
patients with schizophrenia are affected. There is no
particular “schizophrenia gene” that has been identified,
and research continues in the area. A genetic burden
may combine with environmental and social factors to
trigger symptoms.14
Role of neurotransmitters in schizophrenia
The dopamine dysregulation hypothesis has
been fundamental in the development of antipsychotic
medications. The hypothesis states that excessive
dopaminergic activity in the mesolimbic pathway
contributes to positive symptoms such as hallucinations
and delusions. Hypodopaminergic activity in the
mesocortical pathway may contribute to negative
symptoms such as apathy and anhedonia. Besides
dopamine, dysfunction in other neurotransmitter
systems such as glutamatergic, serotonergic,
cholinergic, and GABA-ergic systems have also been
implicated in the pathogenesis of schizophrenia.10,11
Antipsychotics
Antipsychotic medications are classified as
typical and atypical agents. Typical antipsychotics,
which were introduced earlier, are also known as first
generation antipsychotics (FGAs), and atypical agents,
introduced later, are known as second generation
antipsychotics (SGAs). Both classes of antipsychotics
significantly differ in mechanism of action, adverse
effect profile, and receptor pharmacology.15,16 (Table 1)
FGAs, such as chlorpromazine, thioridazine,
Neurodevelopmental model of schizophrenia
The neurodevelopmental aspects in the
pathophysiology of schizophrenia have been
extensively studied using techniques such as imaging
and using biomarkers. Risk factors include prenatal
infection, inflammation, malnutrition, and stress.
Antipsychotics
Adverse effect
Typical Antipsychotics (FGAs)
Mechanism of action
Chlorpromazine
Akathisia
Antagonism of dopamine D2
Thioridazine
Dystonia
receptors
Fluphenazine
Tardive dyskinesia
Trifluoperazine
Drug-induced Parkinsonism
Haloperidol
Atypical Antipsychotics (SGAs)
Clozapine
Olanzapine
Agranulocytosis, weight gain, diabetes,
Antagonism of dopamine D2 and
lipid abnormalities
serotonin 5-HT2A receptors
Weight gain, diabetes, lipid
abnormalities
Quetiapine
Sedation
Risperidone
Movement disorders
Ziprasidone
Cardiac arrhythmias
Table 1. Mechanism of action and adverse effects of antipsychotics
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�Robinson & Darvesh
JMS, May 2023—Volume 2, Issue 1
and haloperidol, are primarily dopamine D2 receptor
antagonists. FGAs block the dopaminergic mesolimbic
pathway and are effective in the management of
positive symptoms. FGAs produce movement disorders
known
as
extrapyramidal
symptoms
(EPS),
pseudoparkinsonism, or drug-induced Parkinsonism by
blocking the dopaminergic nigrostriatal pathway. FGAs
produce EPS such as akathisia (motor restlessness),
dystonia (abnormal repetitive twisting muscle
movements), and tardive dyskinesia (involuntary
abnormal facial movements).17
FGAs also elevate
prolactin levels due to inhibition of the dopaminergic
tuberoinfundibular pathway which regulates prolactin
secretion. Typical antipsychotic-induced hyperprolactinemia is associated with amenorrhea,
osteoporosis, and increased risk for developing breast
cancer.18
Clozapine was the first SGA that was
developed followed by other SGAs, such as olanzapine
and risperidone. The atypicality of SGAs arises from
their antagonist properties at the D2 receptor, which
improves positive symptoms, as well as the antagonism
of serotonin 5-HT2A receptor. Blockade of the 5-HT2A
receptors in the dopaminergic mesocortical pathways
enhances dopamine levels and improves negative
symptoms. Thus, SGAs are effective in improving both
positive and negative symptoms of schizophrenia.
Besides the D2 and 5-HT2A receptors, SGAs also
display antagonism at a multitude of other
dopaminergic,
serotonergic,
muscarinic,
and
histaminergic receptors. SGAs produce several serious
adverse effects such as diabetes, obesity, and cardiac
disturbances.19,20
In this review, we describe the background,
development, receptor pharmacology, mechanism of
Figure 1A. Structure of lumateperone tosylate43
action, pharmacokinetics, clinical trials, adverse effects,
therapeutic uses, and future prospects of lumateperone.
LUMATEPERONE
Lumateperone was developed by Intra-Cellular
Therapies, New York, NY, primarily for the treatment
of schizophrenia with potential use in other
neuropsychiatric disorders such as major depressive
disorders and bipolar disorder. Lumateperone was
called ITI-007 during its development phase, both preclinical studies, and clinical trials. Based on the clinical
data, the FDA approved lumateperone for the treatment
of schizophrenia in adults in December 2019.
Lumateperone, branded as Caplyta®, was available in
February 2020 and is administered in capsule form at a
daily dose of 42 mg.21,22,23,24
Structure
Lumateperone, similar to haloperidol, is
derived from a butyrophenone core (Figure 1A, 1B,
1C). The IUPAC name for lumateperone is 1-(4fluorophenyl)-4-(4-methyl-1,4,12-triazatetracyclo
[7.6.1.05,16.010,15]hexadeca-5,7,9(16)-trien-12-yl)
butan-1-one, and it has a molecular formula of
C24H28FN3O and a molecular weight of 393.5.
Lumateperone is formulated as a tosylate salt to provide
stability to the medication. Lumateperone tosylate has
an IUPAC name 1-(4-fluorophenyl)-4-[(10R,15S)-4methyl-1,4,12-triazatetracyclo[7.6.1.05,16.010,15]
hexadeca-5,7,9(16)-trien-12-yl]butan-1-one;4methylbenzenesulfonic acid; its molecular formula is
C31H36FN3O4S and a molecular weight of
565.7.24,25,26
Figure 1B. Structure of haloperidol44
Figure 1C. Structure of butyrophenone45
Figure 1. Comparison of the structures of lumateperone and haloperidol with their butyrophenone core
3
�Robinson & Darvesh
JMS, May 2023—Volume 2, Issue 1
olanzapine. This accounts for decreased EPS in
lumateperone and olanzapine therapy. Risperidone can
cause significant EPS due to strong binding at the D2
receptor comparable to haloperidol. Lumateperone’s
antidepressant potential is due to its binding at SERT,
which is not present in the other antipsychotic agents. In
summary, Lumateperone’s therapeutic efficacy and
safety are due to its robust binding at the 5-HT2A
receptor, moderate binding at the D2 receptor,
inhibition of SERT, and lack of muscarinic and
histaminergic binding. Lumateperone does not cause
movement
disorders
observed
with
FGAs.
Lumateperone does not produce serious adverse effects
produced by SGAs such as agranulocytosis, weight
gain, diabetes,
lipid abnormalities, and cardiac
arrythmias. Lumateperone also is effective in
management of both positive and negative symptoms
and also improves cognition.36,37
Pharmacology
Lumateperone is an atypical antipsychotic, and
similar to other SGAs, has antagonist properties at both
the D2 and 5-HT2A receptors. Lumateperone has high
binding affinity for the 5-HT2A receptors and displays
moderate binding affinity for the D1 and D2 receptors.
It has low binding affinity for adrenergic α1 and
histaminergic H1 receptors.27,28,29 Lumateperone has a
60-fold higher affinity for the 5-HT2A receptor
compared to the D2 receptor.28,29,30,31 The high 5HT2A / D2 binding ratio, a characteristic of SGAs,
contributes to improvement of negative symptoms.32 It
acts as a presynaptic partial agonist and a postsynaptic
antagonist at the D2 receptor. This pharmacological
effect of decreased presynaptic release of dopamine and
postsynaptic D2 receptor blockade significantly
dampens dopaminergic signaling and thus improves
positive symptoms.28 Lack of binding to muscarinic and
histaminergic receptors results in fewer adverse effects
associated with muscarinic and histaminergic
antagonism in several other antipsychotics.27
Lumateperone causes increased phosphorylation of the
N-methyl-D-aspartate (NMDA) receptor GluN2B
subunit which results in indirect glutamatergic
activation.27 Lumateperone inhibits the serotonin
reuptake transporter (SERT) which may produce
antidepressant effects and also contribute to
improvement of negative symptoms.25
Safety
Lumateperone displays a favorable safety
profile due to its receptor binding profile.36 In clinical
trials, it was well tolerated and did not display the
adverse motor effects nor the metabolic, endocrine, and
cardiovascular effects typically associated with other
FGAs and SGAs.38,39 Some common adverse effects of
lumateperone are headache, dizziness, sedation, fatigue,
nausea, constipation, and vomiting. Lumateperone was
not clinically studied in patients older than 65 years old
and is not recommended for the treatment of dementiarelated psychosis.25,26,38,39
Comparison of receptor binding affinity of lumateperone
with other antipsychotics
Pharmacokinetics
The receptor binding of lumateperone is
compared with two other SGAs, risperidone33 and
olanzapine34, and a FGA, haloperidol,35 in Table 2. For
drug-receptor binding, the smaller the inhibitory
constant (Ki), the greater the binding affinity and the
smaller amount of medication needed in order to inhibit
the activity of that receptor. Lumateperone has robust
binding to the 5-HT2A receptor, which is comparable to
both the SGAs listed in Table 2. Lumateperone shows
moderate binding at the D2 receptor similar to
Lumateperone is rapidly absorbed after oral
absorption, and displays high lipophilicity, which
increases its passage through the blood brain barrier.
Peak plasma concentration is achieved in 1-2 hours and
steady state concentration is achieved in about 5 days.
Lumateperone has a bioavailability of about 4% and is
97.4% protein bound. About 58% of lumateperone is
excreted in urine as water soluble glucuronide
metabolites. Less than 1% of unmetabolized drug is
Drug
Receptors
D1
D2
5HT2A
SERT
α1
α2
H1
Lumateperone
41 nM
32nM
0.54 nM
62 nM
<100 nM
N/A
>1000 nM
Risperidone
N/A
3.13 nM
0.16 nM
>1000 nM
0.8 nM
7.54 nM
2.23 nM
Olanzapine
11 nM
31 nM
4 nM
>1000 nM
19 nM
N/A
7.0 nM
Haloperidol
83 nM
nM
N/A
N/A
N/A
3 nM
N/A
N/A- no significant binding / binding data not available
Table 2. Comparison of inhibitory constant (Ki) of lumateperone with other antipsychotics
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�Robinson & Darvesh
JMS, May 2023—Volume 2, Issue 1
excreted in the urine and 29% is excreted in the
feces.38,39
Lumateperone is a substrate for the enzymes
Cytochrome P450 3A4 (CYP3A4) and Uridine 5'diphospho-glucuronosyltransferase (UGT), and thus
there is potential for drug-drug, drug-food, and drugherb interactions. Lumateperone should not be taken
with CYP3A4 inducers such as the anticonvulsant,
carbamazepine, and the herbal supplement, St. John’s
wort, as they would reduce the plasma concentrations of
the drug. Lumateperone is also contraindicated with
CYP3A4 inhibitors, such as the antidepressant,
fluvoxamine, and grapefruit juice, as they would lead to
an increase in plasma levels of the drug and increase the
chances for toxicity. Drugs known to be UGT inhibitors
such as the anticonvulsant, valproic acid, should not be
used with lumateperone.38,39
•
•
•
The medication and placebo were administered
once daily for 28 days. The primary end point was the
Positive and Negative Syndrome Scale (PANSS). There
was a significant difference between placebo and ITI007 (60 mg). Risperidone also showed a significant
difference compared to placebo. ITI-007 (120 mg) did
not show any statistically significant difference
compared to placebo. A subgroup of patients with
symptoms of depression were evaluated with the
Calgary Depression Scale for Schizophrenia (CDSS).
Only ITI-007 (60 mg) showed a significant difference
compared with placebo for the depression symptoms. 40
Clinical Trials
Lumateperone was clinical evaluated to study
its therapeutic effectiveness and potential adverse
effects. Two clinical trials were conducted to determine
the efficacy and safety of lumateperone are discussed in
this section.
NCT02282761
This phase III clinical trial compared placebo
with two doses of ITI-007 (lumateperone tosylate), 40
and 60 mg, which are equivalent to 28 and 48 mg of
lumateperone base. This clinical study was conducted
from November 2014 to September 2015. 450 patients
with schizophrenia were enrolled in this study in a
randomized, double-blind, 1:1:1 fashion.
NCT01499563
This clinical trial was a phase II multicenter
study that compared placebo and risperidone (4 mg), as
positive control, with two doses of ITI-007
(lumateperone tosylate) (60 mg and 120 mg) which are
equivalent to 42 mg and 84 mg of lumateperone being
used to determine effects of ITI-007 on psychosis. The
study was conducted from December 2011 to November
2013. The study was conducted in a randomized doubleblind manner in a 1:1:1:1 fashion. A total of 355 acutely
psychotic patients were enrolled into the study.
Inclusion Criteria:
•
•
•
•
Inclusion Criteria:
•
•
•
“Patient's age is 18-55
Patient has current diagnosis of schizophrenia and
is experiencing an acute exacerbation of psychosis
Patient has a history of at least three months
exposure to one or more antipsychotic therapy(ies)
and a prior response to antipsychotic therapy within
the previous five years”40
•
•
“Patient’s age is 18-60
Patient has a clinical diagnosis of schizophrenia
Patient is male or female of any race
Patient is experiencing an acute exacerbation of
psychosis”41
Exclusion Criteria:
•
•
•
Exclusion Criteria:
•
depression with psychotic features
Any patient considered to be an imminent danger to
themselves or others
Any patient with hematological, renal, hepatic,
endocrinological, neurological, or cardiovascular
disease or substance abuse as defined by protocol
Any patient judged by the investigator to be
inappropriate for the study”40
“Any female patient who is pregnant or breastfeeding
Any patient unable to provide informed consent
Any patient judged by the Investigator to be
inappropriate for the study.”41
The patients were administered medication or
placebo once daily for a period of 28 days. The primary
end point was the PANSS. ITI-007 (60 mg) showed a
significant difference compared to placebo for PANSS
while the lower dose of 40 mg did not. Both doses of
ITI-007 showed significant difference compared to
placebo for secondary end points, Clinical Global
Impression-Severity of Illness (CGI-S) scores, and the
general psychopathology subscale scores.41
“Any female patient who is pregnant or breastfeeding
Any patient presenting with concurrent dementia,
delirium, mental retardation, epilepsy, druginduced psychosis, or history of significant brain
trauma
Any patient presenting with schizoaffective
disorder, bipolar disorder, acute mania, or major
5
�Robinson & Darvesh
JMS, May 2023—Volume 2, Issue 1
Overall, lumateperone showed efficacy in
improving symptoms of schizophrenia as well as
depression symptoms and also demonstrated a superior
safety profile in both aforementioned clinical trials.
5.
Yuhas D. Throughout History, Defining
Schizophrenia Has Remained a Challenge
[Timeline]. Scientific American Mind and Brain.
https://www.scientificamerican.com/article/
throughout-history-defining-schizophrenia-hasremained-challenge/. Published March 1, 2013.
Accessed April 27, 2022
6.
Andreasen NC, Nopoulos P, Schultz S, et al. Positive
and negative symptoms of schizophrenia: past, present,
and future. Acta Psychiatr Scand Suppl. 1994;384:5159. doi:10.1111/j.1600-0447.1994.tb05891.x.
7.
Khan ZU, Montanez-Martin E, Muly EC. Schizophrenia:
causes and treatments. Curr Pharm Des. 2013;19
(36):6451-6461. doi:10.2174/1381612811319360006
8.
Stilo SA, Murray RM. Non-Genetic Factors in
Schizophrenia. Curr Psychiatry Rep. 2019;21
(10):100. doi:10.1007/s11920-019-1091-3
9.
Owen MJ, Sawa A, Mortensen PB. Schizophrenia.
Lancet. 2016;388(10039):86-97. doi:10.1016/S0140
-6736(15)01121-6
CONCLUSION
Schizophrenia is an extremely complex and
debilitating mental illness with poorly elucidated
pathophysiology.
The
pharmacotherapy
of
schizophrenia is beset with serious and life-threatening
adverse effects such as movement disorders,
agranulocytosis, weight gain, diabetes, and cardiac
arrythmias. Thus, there exists a critical need for the
development of newer antipsychotic agents with an
improved therapeutic and safety profile. The receptor
pharmacology of antipsychotic agents is well
characterized and is linked to their therapeutic and
adverse effects. This knowledge is advantageous in the
development of newer antipsychotics
Lumateperone is one of the newly developed
atypical antipsychotics in recent years. It has
significantly higher binding affinity to the 5-HT2A
receptor and moderate binding at the D2 receptor. It has
a good safety profile and has been shown to be devoid
of any significant motor, metabolic, endocrine, and
cardiovascular adverse effects. It has been shown to be
effective in the management of schizophrenia
symptoms. Lumateperone’s ability to inhibit SERT
contributes to it’s ability to manage negative and
depression symptoms. Lumateperone was approved by
the FDA for the treatment of bipolar depression in
December 2021.42 Since the drug has been on the
market for less than three years, there are no studies
evaluating any possible long-term effects of
lumateperone.
10. McCutcheon RA, Abi-Darghan A, Howes OD.
Schizophrenia, Dopamine and the Striatum: From
Biology to Symptoms. Trends Neurosci. 2019;42
(3):205-220. doi:10.1016/j.tins.2018.12.004
11. Grace AA. Dysregulation of the dopamine system
in the pathophysiology of schizophrenia and
depression. Nat Rev Neurosci. 2016;17(8):524-532.
doi:10.1038/nrn.2016.57
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antipsychotic drugs. Annu Rev Med. 2013;64:393406. doi:10.1146/annurev-med-050911-161504
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16. Chokhawala K, Stevens L. Antipsychotic
Medications. In: StatPearls. Treasure Island (FL):
StatPearls Publishing; September 26, 2022.
25. Vyas P, Hwang BJ, Brašić JR. An evaluation of
lumateperone tosylate for the treatment of
schizophrenia. Expert Opin Pharmacother. 2020;21
(2):139-145. doi:10.1080/14656566.2019.1695778
17. Musco S, Ruekert L, Myers J, et al. Characteristics
of Patients Experiencing Extrapyramidal Symptoms
or Other Movement Disorders Related to Dopamine
Receptor Blocking Agent Therapy. J Clin
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JCP.0000000000001061
26. Syed AB, Brasic JR. The role of lumaterone in the the
treatment of schizophrenia. Ther Adv Psychopharmacol.
2021;11:1-14. doi:10.1177/20451253211034019
27. Snyder GL, Vanover KE, Davis RE, et al. A review
of the pharmacology and clinical profile of
lumateperone for the treatment of schizophrenia.
Adv Pharmacol. 2021; 90:253-276. doi:10.1016/
bs.apha.2020.09.001
18. Rajkumar RP. Prolactin and psychopathology in
schizophrenia: a literature review and reappraisal.
Schizopher
Res
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doi:10.1155/2014/175360
28. Vanover KE, Davis RE, Zhou Y, et al. Dopamine
D2 receptor occupancy of lumateperone (ITI-007):
a Positron Emission Tomography Study in patients
with schizophrenia. Neuropsychopharmacology.
2019;44(3):598-605. doi:10.1038/s41386-018-0251
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19. Aringhieri S, Carli M, Kolachalam S, et al.
Molecular targets of atypical antipsychotics: From
mechanism of action to clinical differences.
Pharmacol Ther. 2018;192:20-41. doi:10.1016/
j.pharmthera.2018.06.012
20. Kearns B, Copper K, Cantrell A, Thomas C.
Schizophrenia Treatment with Second-Generation
Antipsychotics: A Multi-Country Comparison of
the Costs of Cardiovascular and Metabolic Adverse
Events and Weight Gain. Neuropsychiatr Dis Treat.
2021;17:125-137. doi:10.2147/NDT.S282856
29. Edinoff A, Wu N, deBoisblanc C, et al.
Lumateperone for the Treatment of Schizophrenia.
Psychopharmacol Bull. 2020;50(4):32-59.
30. Correll CU, Davis RE, Weingart M, et al. Efficacy
and Safety of Lumateperone for Treatment of
Schizophrenia. JAMA Psychiatry. 2020;77(4):349–
358. doi:10.1001/jamapsychiatry.2019.4379
21. Intra-Cellular Therapies. FDA approves intracellular
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antipsychotic,
CAPLYTA® (lumateperone) for the treatment of
schizophrenia in adults. Intracellular Therapies Inc.
https://ir.intracellulartherapies.com/news-releases/
news-release-details/fda-approves-intra-cellulartherapies-novel-antipsychotic. Published Dec 23,
2019. Accessed November 26, 2021.
31. Meyer JM. Lumateperone for Schizophrenia. Curr
Psychiatry. 2020;19(2):33-39.
32. Corponi F, Fabbri C, Bitter I, et al. Novel
antipsychotics specificity profile: A clinically oriented
review of lurasidone, brexpiprazole, cariprazine, and
lumateperone. Eur Neuropsychopharmacol. 2019;29
(9):971-985. doi:10.1016/j.euroneuro.2019.06.008
22. Davis RE, Correll CU. ITI-007 in the treatment of
schizophrenia: from novel pharmacology to clinical
outcomes. Expert Rev of Neurother. 2016;16
(6):601-614. doi: 10.1080/14737175.2016.1174577
33. Fenton C, Scott LJ. Risperidone. CNS Drugs. 2005;19
(5):429-444. doi: 10.2165/00023210-200519050-00005.
23. Kane JM, Durgam S, Satlin A, et al. Safety and
tolerability of lumateperone for the treatment of
schizophrenia: a pooled analysis of late-phase
placebo- and active-controlled clinical trials. Int
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2021;36(5):244-250.
doi:10.1097/YIC.0000000000000371
34. Callaghan JT, Bergstrom RF, Ptak LR, Beasley CM.
Olanzapine. Pharmacokinetic and pharmacodynamic
profile. Clin Pharmacokinet. 1999;37(3):177-193.
doi:10.2165/00003088-199937030-00001
24. Greenwood J, Acharya RB, Marcellus V, Rey JA.
Lumateperone: A Novel Antipsychotic for
Schizophrenia. Ann of Pharmacother. 2021;55
(1):98-104. doi:10.1177/1060028020936597
35. Peprah K, Zhu XY, Eyunni SV, et al. Multireceptor drug design: Haloperidol as a scaffold for
the design and synthesis of atypical antipsychotic
agents. Bioorg Med Chem. 2012;20(3):1291-1297.
doi:10.1016/j.bmc.2011.12.019
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36. Orsolini L, De Berardis D, Volpe U. Up-to-date
expert opinion on the safety of recently developed
antipsychotics. Expert Opin Drug Safe. 2020;19
(8):981-998. doi: 10.1080/14740338.2020.1795126
45. National Center for Biotechnology Information.
PubChem Compound Summary for CID 10315,
Butyrophenone. https://pubchem.ncbi.nlm.nih.gov/
compound/Butyrophenone. Accessed October 24,
2022.
37. Calabrese JR, Durgam S, Satlin A, et al. Efficacy and
Safety of Lumateperone for Major Depressive
Episodes Associated With Bipolar I or Bipolar II
Disorder: A Phase 3 Randomized Placebo-Controlled
Trial. Am J Psychiatry. 2021;178(12):1098-1106.
doi:10.1176/appi.ajp.2021.20091339
ACKNOWLEDGMENTS
The authors wish to gratefully acknowledge the
valuable insight and opinions provided by Dr.
Takhar Kasumov, Dr. Woo Shik Shin, and Dr.
Chris Paxos.
38. Intra-Cellular Therapies Inc. Caplyta (lumateperone)
capsules for oral use (package insert). New York.
https://www.intracellulartherapies.com/
Accessed
January 07, 2023.
CONFLICTS OF INTEREST
39. Blair HA. Lumateperone: First Approval. Drugs.
2020;80(4):417-423. doi: 10.1007/s40265-020-012716
All authors declare no conflicts of interest.
AUTHOR CONTRIBUTIONS
40. ClinicalTrials.gov. U.S. National Library of
Medicine. Study of a Novel Antipsychotic ITI-007
in Schizophrenia. https://clinicaltrials.gov/ct2/
show/results/NCT01499563. Updated March 10,
2017. Accessed February 15, 2022.
Review Writing: GR
Editing: AD
41. Clinical Trials.gov. U.S. National Library of
Medicine. A Trial to Assess the Antipsychotic
Efficacy of ITI-007. https://clinicaltrials.gov/ct2/
show/NCT02282761. Updated March 10, 2017.
Accessed February 16, 2022.
42. Intra-cellular Therapies Inc. Cellular therapies
announces U.S. FDA approval of CAPLYTA®
(lumateperone) for the treatment of bipolar
depression in adults: Intra-Cellular Therapies Inc.
https://ir.intracellulartherapies.com/news-releases/
news-release-details/intra-cellular-therapiesannounces-us-fda-approval-caplytar. Published Dec
20, 2021. Accessed February 17, 2022.
43. National Center for Biotechnology Information.
PubChem Compound Summary for CID
44241743, Lumateperone Tosylate. https://
pubchem.ncbi.nlm.nih.gov/compound/
lumateperone-Tosylate. Accessed October 24,
2022.
44. National Center for Biotechnology Information.
PubChem Compound Summary for CID 3559,
Haloperidol.
https://pubchem.ncbi.nlm.nih.gov/
compound/Haloperidol. Accessed October 24,
2022.
8
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Lumateperone in the Treatment of Schizophrenia: A Review
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Robinson GT; Darvesh AS
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antipsychotic; atypical; lumateperone; schizophrenia; 5-HT2A serotonin receptor
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Schizophrenia is a devastating mental illness that afflicts about 1% of the world’s population. This illness distorts a person’s perception of reality and consists of positive symptoms such as hallucinations and delusions, negative symptoms such as inattention and withdrawal, and cognitive deficits. Antipsychotic drugs are primarily used for the pharmacotherapy of schizophrenia. In this article, we provide a succinct review of a recently approved novel antipsychotic, lumateperone. We present an overview and history of schizophrenia, its symptoms, epidemiology, etiology, and pathophysiology. The classification of antipsychotic agents as first and second-generation based on their receptor affinity is discussed. The review focuses on describing the background, development, receptor pharmacology, mechanism of action, pharmacokinetics, clinical trials, adverse effects, therapeutic uses, and future prospects of lumateperone.
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Journal of Medical Sciences at NEOMED
Volume 2, Issue 1, May 2023
A Review of the Predisposition to Child Abuse
Sonia Kshatri, BS1 and Hannah Girgis, BS1
1.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, 44272
ABSTRACT
This present review focuses on evaluating works investigating potential risk factors for child abuse. Child
abuse is a complex issue, which has many contributing risk factors. Child abuse encompasses physical
abuse, sexual abuse, emotional abuse, and child neglect. Each component has its own consequence to a
child's health and wellbeing. Theories have been developed to explain the causes of and the predisposition
to child abuse. Several studies exist which investigate the relationship between child abuse and a variety
of risk factors. Risk factors that have been shown to correlate with child abuse include parental problems
and difficulties, prior sexual abuse victimization of a child or siblings, social isolation of a child and
family, child drug use, poor social skills, parental substance abuse, and neighborhood risk factors.
Focusing on these theories and risk factors can lead to a better understanding of the predisposition to child
abuse.
Keywords: child abuse, risk factors, predisposition
INTRODUCTION AND BACKGROUND OF
CHILD ABUSE
There are numerous risk factors that
predispose children to child abuse. Many children who
are subject to these risk factors and child abuse
experience short- and long-term cognitive, physical,
psychiatric, and generational consequences due to their
victimization.5 Because of the effects of child abuse and
maladaptation on its victims, understanding and
identifying risk factors of abuse can act as a
preventative health measure. Most cases of child abuse
are first identified at the emergency department;6 thus,
the components and endangerments of child abuse are
important for health care professionals to understand.
This literature review will look into factors that put
children at greater risk of abuse.
Child maltreatment and abuse are complex
issues that include neglect, emotional or psychologic
abuse, physical abuse, and sexual abuse. The CDC’s
Injury Center defines child maltreatment and abuse as
“abuse and neglect inflicted by a parent, caregiver, or
another person in a custodial role upon a child under
18”.1 Child neglect, on the other hand, is composed of
“negative” behaviors in which the caretaker disregards
caretaking behaviors that are important for normal
physical and emotional development of the child. This
includes neglect in physical, emotional, medical, mental
health, education, and supervision.2 The most
frequently found form of abuse is neglect.3 Physical
abuse includes behaviors such as beating and shaking,
as well as burning and biting. Rib fractures are the most
common findings of physical abuse. Child sexual abuse
(CSA) can be defined as “the involvement of
dependent, developmentally immature children and
adolescents in sexual activities which they do not fully
comprehend, to which they are unable to give consent,
or that violate the social taboos of family roles.”3 Sexual
abuse includes contact sexual abuse (e.g., involving
oral, anal, or vaginal penetration) and non-contact. Noncontact sexual abuse includes exposure to sexually
explicit materials as well as oral-genital and genital-togenital contact.3,4 Another type of child abuse is
psychological abuse, which includes “verbal abuse,
humiliation, and acts that scare or terrorize a child.”3
EXPLORING PREDISPOSITION TO CHILD
ABUSE
Several theories (Table 1)4 propose the
characteristics of a child or their environment that may
lead to their victimization. These theories demonstrate
activities that expose children to offenders, lack of
parental/guardian supervision, parental experiences, the
culture of the child’s community, and a child’s
characteristics as components that cause increased
susceptibility to abuse.
One meta-analysis observed the multiple
contributions on an individual, parental, and familial
level to the total risk of victimization to CSA. This meta
-analysis stratified 765 risk factors into 35 risk domains
1
�Kshatri & Girgis
JMS, May 2023—Volume 2, Issue 1
Theory
Definition
Routines Activities Theory
Suitable targets are most susceptible to crime in
presence of likely offenders and offenders are most
likely to commit crime in the absence of guardians10
Target Suitability
Three parts of this theory:4
1) Target vulnerability: child’s lack of capacity to deter
victimization
2) Target gratifiability: a child’s quality that an
offender wants to have or manipulate
3) Target antagonism: a child’s quality that an offender
feels angry towards or causes the offender to exhibit
destructive impulses
Three domains:11
Belsky’s Developmental-Ecological Model
1) The developmental-psychological (child and
caregiver characteristics)
2) Immediate (caregiver interaction and home
environment)
3) Broader domain (neighborhood characteristics)
Ecological, Transactional, and Developmental Model
Susceptibility and vulnerability to child abuse relies on
the dynamic transaction between concrete risk factors
and a child’s developmental (cognitive, affective, or
physiological) maturity4
Table 1. Theories of Child Abuse
and studied their association with CSA.4 From these
domains, risk themes were created: (prior)
victimization, parental problems and difficulties, nonnuclear family structure, family (system) problems,
child problems, and child characteristics. Of the 35
domains, 23 domains showed small (r=0.1), medium
(r=0.3), and large (r=0.5) mean effects. 5 Data revealed
that the strongest association to CSA existed in those
with victimization or prior victimization of siblings,
other family members (r=0.283), or parents (r=0.265).
Thus, the risk theme “(prior) victimization” had the
strongest effect on susceptibility to CSA. Domains of
the “parental problems and difficulties” theme,
including intimate partner violence (r=0.175), substance
use or abuse in parents (r=0.171), health problems in the
parent (r=0.169), and a low level of parental education
(r=0.151), showed small or medium effects on CSA.
The existence of “non-nuclear families,” such as the
presence of a stepfather (r=0.118), may also pose a risk
to children. Domains under “family (systems)
problems,” which were associated with risk of CSA,
include problems in functioning of the family system
(r=0.194), social isolation of child and family (r=0.191),
and low socioeconomic status (p=0.101). The final two
risk themes discussed are “child characteristics” and
“child problems.” Child problems that increase risk of
victimization
include
chronic
physical/mental
conditions (r=0.193) and delinquent behavior and drug
use (r=0.126). As for child characteristics, children who
exhibit poor social skills or shyness (r=0.217), frequent
internet use (r=0.152), and were of female gender
(r=0.290) may be at risk for CSA.
2
�Kshatri & Girgis
JMS, May 2023—Volume 2, Issue 1
In a separate meta-analysis, 315 risk factors
were stratified into 24 risk domains to see their effect on
child neglect.2 Risk domains were classified into effect
sizes: small (r>0.100), medium (r>0.243), and large
(r>0.371). The strongest predictors of neglect were
parental characteristics, with the strongest being a
history of parental antisocial behavior and criminal
offending (r=0.372). Other parental characteristics
showing significant effects were low education level
(r=0.229), mental/psychiatric problems (r=0.259),
single marital status (r=0.285), mental/physical
problems (r=0.207), and parental history of abuse
(r=.182). This meta-analysis did not find a significant
association between child abuse and parental substance
abuse (p=0.234), unemployment (p=0.97), adverse
childhood experiences (p=0.62), or adverse parental
notions on pregnancy (p=0.594). On the level of a
child's characteristics, the following showed significant
effects: non-Caucasian ethnicity (r=0.216), perinatal
problems (r=0.185), and child’s mental/physical/
behavioral problems (r=0.171). Unlike another study, 6
this analysis showed no association between female sex
(p=0.954) or age (p=0.618) and child abuse. On the
level of a family’s characteristics, six of seven risk
domains showed significant effects. These include low
socioeconomic status (r=0.166), physical violence at
home (r=0.197), two or more children in the household
r=0.186), children not living with both biological
parents (r=0.120), and problematic family behaviors
and cognitions (r=0.110). Low social support did not
reveal a significant effect (p=0.313).6
Parental substance abuse, as a significant risk
domain, was explored in a study that evaluates the
relationship between substance use disorder and risk
potential.7 In this study, examinees were screened with
Child Abuse Potential Inventory (CAPI). CAPI is a 160
-item measure of a parent’s inclination to engage in
physically abusive behavior scaled from 0 to 468; an
elevated score is defined as above 215 and indicates that
the parent has characteristics resembling known, active
child abusers. Both mothers and fathers with a history
of substance abuse scored higher on CAPI (p<0.001).
However, there were no statistical significance in abuse
potential between previous versus current drug users
(p>0.05). According to CAPI, history of parental drug
use is associated with impaired parental functioning and
puts vulnerable parents at increased abuse potential.
This study also evaluated parents’ personality
characteristics using the Multidimensional Personality
Questionnaire (MPQ). It was found that positive and
negative affectivity (both components of emotional
dysregulation) were significant (p<0.001 and p=0.000,
respectively) in increasing abuse potential, suggesting
the role of substance abuse in psychological
maladjustment.7
One study investigated the effect of
neighborhood-level risk and protective factors in
addition to individual factors in 3000 families across 50
cities in California.8 This study found that there was a
significant association (p<0.05) between neighborhood
poverty and corporal punishment/physical neglect.
However, lower income families (<200% of poverty
line) had statistically significant (p<0.05) higher rates of
corporal punishment and physical neglect in comparison
to higher income families (>200% above poverty line)
residing in the same area. In lower income households,
neighborhood turnover was associated with severe
assault and corporal punishment (p<0.10). This was
potentially because a transient neighborhood made it
difficult to form long-term relationships with neighbors.
In contrast, this study found that at an individual level,
short term residence in neighborhoods was associated
with decreased odds of corporal punishment. The
authors attributed this finding to the fact that residing in
a neighborhood long-term may only be beneficial if the
neighborhood had positive qualities.8 The size of a
parent’s social network and informal social support,
such as in the form of reciprocated exchange with
neighbors, was a protective factor against both abuse
and neglect.8 This finding could be explained by the
enhancement of parental mental state, which reduced
maltreatment.9 Additionally, perceived informal social
control, defined as “shared expectations and norms that
neighbors will act in the interests of the common
good”,9 decreased corporal punishment and physical
abuse. However, this effect was only seen in higher
income families.8
CONCLUSION
Modifiable risk factors for CSA related to a
child’s characteristics include frequent internet use,
drug use, and delinquent behavior; non-modifiable risk
factors related to a child’s characteristics include form
of victimization other than child abuse, female sex, low
quality of a child’s relation with parent, and chronic
physical or mental conditions. Risk factors for CSA
associated with a child’s parent that are important to
recognize are parental relationship problems, substance
abuse, parental history of child abuse victimization,
mental/psychiatric health problems, physical health
problems, low level of parental education, and low
sense of parenting competence. Risk factors related to a
family and surrounding environment that were related
to child abuse are prior abuse of a child or their sibling
or other family member, high neighborhood turnover,
neighborhood poverty, problems in the family system
functioning, social isolation, concurrent forms of child
abuse in the home, non-nuclear family structure, low
socioeconomic status, and presence of a stepfather.
Overall, the two strongest risk themes for CSA were
previous victimization to other kinds of child abuse and
prior sexual abuse victimization of child or sibling. This
suggests that a history of child abuse in the child’s
home led to increased susceptibility for a child to
experience CSA. Unfortunately, abuse may be
underreported. In those cases where clinical suspicion
for child abuse remains high, evaluation of other risk
factors may help support the likelihood of abuse.
Those risk factors related to child’s
3
�Kshatri & Girgis
JMS, May 2023—Volume 2, Issue 1
REFERENCES
characteristics that do not significantly affect CSA are
gender nonconforming behavior; however, the metaanalysis that evaluated sexual abuse only included one
study that focused on gender nonconformity.4 Risk
factors associated with a child’s parent that were not
associated with child abuse were young maternal age,
conservative sexual and family values, parental
unemployment, and dysfunctional maternal attitudes.
Risk factors related to a family structure that did not
show significant effect included family history of
criminal behavior, large family size, presence of
psychiatric condition in a child's sibling, strong
religious affiliations, or living within a violent
community.
Statistically significant risk factors for all child
abuse related to a child’s characteristics gathered from
meta-analyses, that were statistically significant were
perinatal problems and non-Caucasian ethnicity. Female
sex, however, was not an attributable risk factor for
child abuse overall, a finding that differed from CSA
alone. This could be potentially explained by the target
suitability theory, which suggested that the offender was
inclined to certain characteristics of a child, such as
female gender, and more vulnerable for specific
scenarios such as CSA. In terms of parental
characteristics, risk factors that were attributed to abuse
were parental mental and physical problems, mental and
psychiatric problems, history of substance abuse,
current substance abuse, and prenatal problems. Risk
factors which were related to abuse regarding the family
unit were low family socioeconomic status and a child
not living with two biological parents. Large family size
was a significant risk factor for abuse overall. This
finding contrasted with CSA; however, in the analysis
assessing CSA, no numerical value for number of
family members was stated, while >2 children was
considered large for child abuse overall. The strongest
risk factors associated with abuse overall were parental
mental or physical problems and prenatal problems.
This suggested that complications in parental health
status could increase the chances that a child will
become a victim of child abuse. Risk factors which
were not significant included low social support, child’s
mental or physical problems, adverse parental cognition
regarding pregnancy, parental unemployment, and
parental history of criminal offending.
There are many risk factors for child abuse,
some more significant than others. Some risk factors are
modifiable, such as parental substance abuse or frequent
internet use. Thus, clinicians can motivate patients and
family to improve upon those risk factors. Scenarios in
which there is a clinical suspicion for child abuse
should warrant evaluation, including a history of risk
factors. This is relevant due to the short- and long-term
consequences of child abuse on the development of a
child. An area for further research should include the
frequency of certain risk factors to assess for
prevalence, as this would help guide clinical
questioning in regards to assessing for child abuse.
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risk factors for physical child abuse and Child neglect:
Variations by poverty status. Child Maltreatment.
2017;22(3):215-226. doi:10.1177/1077559517711806
9.
Thompson RA. Social Support and Child
Protection: Lessons Learned and learning. Child
Abuse & Neglect. 2015;41:19-29. doi:10.1016/
j.chiabu.2014.06.011
10. Culatta E, Clay-Warner J, Boyle KM, Oshri A.
Sexual Revictimization: A Routine Activity Theory
Explanation. Journal of Interpersonal Violence.
2020;35(15-16):2800-2824.
11. Begle AM, Dumas JE, Hanson RF. Predicting child
4
�Kshatri & Girgis
JMS, May 2023—Volume 2, Issue 1
abuse potential: an empirical investigation of two
theoretical frameworks. J Clin Child Adolesc Psychol.
2010;39(2):208-219. doi:10.1080/15374410903532650
ACKNOWLEDGMENTS
We gratefully thank Trinity Samson for her
guidance with this review and her encouragement
throughout this process.
CONFLICTS OF INTEREST
All authors declare no conflicts of interest.
AUTHOR CONTRIBUTIONS
Manuscript Preparation: SK, HG
Manuscript Research: SK
Initial Research: HG
5
�
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Journal of Medical Sciences at NEOMED (Vol2Issue1)
Volume 2 Issue 1 - February 2023
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Journal of Medical Sciences at NEOMED
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The Journal of Medical Sciences at NEOMED is an online, student-led, peer-reviewed scholarly journal created to provide a platform for NEOMED students, faculty and affiliates to publish original research, opinion pieces, editorials, reviews, abstracts and other works.
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Title
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A Review of the Predisposition to Child Abuse
Creator
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Kshatri S; Girgis H
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Journal of Medical Sciences at NEOMED
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2023
Subject
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child abuse; risk factors; predisposition
Description
An account of the resource
This present review focuses on evaluating works investigating potential risk factors for child abuse. Child abuse is a complex issue, which has many contributing risk factors. Child abuse encompasses physical abuse, sexual abuse, emotional abuse, and child neglect. Each component has its own consequence to a child's health and wellbeing. Theories have been developed to explain the causes of and the predisposition to child abuse. Several studies exist which investigate the relationship between child abuse and a variety of risk factors. Risk factors that have been shown to correlate with child abuse include parental problems and difficulties, prior sexual abuse victimization of a child or siblings, social isolation of a child and family, child drug use, poor social skills, parental substance abuse, and neighborhood risk factors. Focusing on these theories and risk factors can lead to a better understanding of the predisposition to child abuse.
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145ba112bdca5581c9c132b1375919d2
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Text
Journal of Medical Sciences at NEOMED
Volume 2, Issue 1, May 2023
Prescription Drug Donation and the Private Sector—Why Ohio’s Medical Students Should
Care
Jonathan Markle, BS1
1.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, 44272
ABSTRACT
This perspective piece discusses the important role donation of prescription medication from the private
sector plays in the financial health of Ohio’s free clinics and the patients they serve. It also discusses
recent changes in Ohio’s nursing home industry that have altered this vital pipeline, why medical students
should care about them, and a personal anecdote from the author about the impact these changes can have
on patients.
Keywords: prescriptions, prescription donation, drug depository, free clinics
LEGISLATIVE INNOVATIONS IN
RESPONSE TO RISING PRESCRIPTION
EXPENSES
OHIO’S FREE CLINICS AND THE PRIVATE
SECTOR
In the State of Ohio, over 50 free clinics
provide services to more than 100,000 patients
annually, including medical student-run free clinics.10,11
Ohio passed legislation in 2003 establishing a Drug
Donation Repository program, which was the first in
the nation to allow nursing homes and long-term care
pharmacies to become donators of medication.8,12 Since
its inception, Ohio’s program has redistributed several
million dollars’ worth of prescriptions, including more
than half a million annually in the past several years.13
However, due to recent corporate mergers, the
nursing home industry in Ohio has undergone
significant consolidation, with negative impacts on the
Ohio Drug Donation Repository. In 2015, CVS
purchased Omnicare, which had been the United States’
largest provider of pharmaceutical services in nursing
homes.14 Before its acquisition by CVS, Omnicare was
a significant contributor to the Ohio Drug Donation
Repository. However, after purchasing Omnicare, CVS
elected to cease donations to Ohio’s program, citing a
need to comply with the federal 2013 Drug Supply
Chain Security Act (DSCSA) and contractual
agreements with pharmaceutical manufacturers.12 While
the DSCSA requires corporate entities to take steps to
prevent consumers from exposure to “counterfeit,
stolen, contaminated, or otherwise harmful” drugs, the
legislation that governs Ohio’s Repository program
grants legal immunity to all participants so long as
medications are donated in good faith.15,16 While no
formal analysis has yet been conducted as to the impact
of CVS’ withdrawal, participants in the program have
remarked that this would likely “hurt [the Ohio Drug
Donation Repository program] quite a bit”.12
Out-of-pocket cost is a consistent predictor of
patient nonadherence to a prescription medication
regimen.1,2 As such, decreasing these expenses is a
public health intervention that has been shown to
improve patient adherence and, ultimately, health
outcomes.2,3
Partially due to increased prescription costs,
the nationwide demand for services of free clinics has
increased, with more than 1.8 million patients seeking
care at 1200+ free clinics.4 Just as medication expenses
can lead to nonadherence, threatening the health of
individual patients, it can also threaten the financial
health of free clinics. For some, prescription expenses
have ballooned to 58-63% of total expenditures.5,6 In
the United States, legislation has been passed to allow
charitable donation of prescription medication to
registered free clinics and charitable pharmacies. In 40
states, including Ohio, additional legislation
establishing “Drug Donation Repository” programs has
also been passed.7,8 Broadly speaking, Drug Donation
Repository legislation allows prescription recipients and
private entities (such as manufacturers, wholesalers,
nursing homes, long-term care facilities, etc.) to donate
prescription medication to free clinics and charitable
pharmacies, as long as the medication is not expired
and is in its original packaging.7,8 Repository programs
have allowed several states to repurpose tens of
millions of dollars’ worth of medication that would
otherwise be disposed of.7,9
1
�Markle
JMS, May 2023—Volume 2, Issue 1
WHY OHIO MEDICAL STUDENTS
SHOULD CARE
REFERENCES
Today, there are at least 111 medical studentrun free clinics, including five in Ohio.17-23 While not
all of these free clinics offer prescription services, the
ones that do report spending similar percentages of their
budgets on medications as those that are not studentrun.5,6 Maintaining the financial security of these clinics
should thus be a priority for medical students because
for many, especially in the preclinical years, the
experiences gained at these clinics remind them why
they chose a career in medicine.17,18
I speak from personal experience in this
regard. Prior to the COVID-19 pandemic, I volunteered
as a laboratory technician at OPEN M, a free clinic in
Akron, both as an undergraduate and a preclinical
medical student. The experiences I had there as a
volunteer kept me connected to my original reasons for
wanting to become a physician during a time when I
was otherwise far removed from clinical medicine. But
one night in September 2018, the clinic ran out of
metformin. I queried the clinic chief about how this
happened, as metformin seemed like an important
medication to keep a large stock of. The chief replied
that their metformin stock had significantly decreased
after CVS withdrew from the Drug Donation
Repository. As a result, the patients with a metformin
prescription—many without personal transportation and
working jobs that gave little or no paid time off—would
have to come back to the clinic much earlier than they
otherwise would have to refill their prescriptions. As
such, this unfortunate indirect effect of the CVS
withdrawal from the Drug Donation Repository directly
affected the clinic and the medically underserved
populations it served.
Clinical experiences at free clinics help keep
many medical students connected to why they chose
medicine as a career. Thus, to preserve both the
financial health of these clinics and the patients they
serve, Ohio’s medical students should advocate for
increased participation in the Ohio Drug Donation
Repository.
1.
Khera R, Valero-Elizondo J, Das SR, et al. CostRelated Medication Nonadherence in Adults
With Atherosclerotic Cardiovascular Disease in
the United States, 2013 to 2017. Circulation.
2019;140(25):2067-2075. doi:10.1161/
CIRCULATIONAHA.119.041974
2.
Choudhry NK, Bykov K, Shrank WH, et al.
Eliminating Medication Copayments Reduces
Disparities In Cardiovascular Care. Health Aff
(Millwood). 2014;33(5):863-870. doi:10.1377/
hlthaff.2013.0654
3.
Brinegar - The Impact of Medication Donation
Repositories A. Accessed November 21, 2021.
https://uknowledge.uky.edu/cgi/viewcontent.cgi?
article=1237&context=cph_etds
4.
Darnell JS. Free Clinics in the United States: A
Nationwide Survey. Arch Intern Med. 2010;170
(11):946-953. doi:10.1001/archinternmed.2010.107
5.
Batra J, Xu H, Rifkin RA, et al. Containing
Prescription Drug Costs at a Resource-Limited,
Student-Run Clinic for the Uninsured. J Stud-Run
Clin. 2017;3(1). Accessed February 7, 2022.
https://journalsrc.org/index.php/jsrc/article/view/59
6.
Arao RK, O’Connor MY, Barrett T, et al.
Strengthening value-based medication management
in a free clinic for the uninsured: Quality
interventions aimed at reducing costs and
enhancing adherence. BMJ Open Qual. 2017;6
(2):e000069. doi:10.1136/bmjoq-2017-000069
7.
State Prescription Drug Repository Programs.
Accessed November 21 2021. https://www.ncsl.org/
research/health/state-prescription-drug-return-reuse
-and-recycling.aspx
8.
Operating a Drug Repository Program.pdf. Accessed
February 7, 2022. https://www.pharmacy.ohio.gov/
Documents/Pubs/Special/DrugRepository/
Operating%20a%20Drug%20Repository%
20Program.pdf
9.
Wyoming
Medication
Donation
Program.
Wyoming Department of Health. Accessed
February 7, 2022. https://health.wyo.gov/healthcarefin/
medicationdonation/
CONCLUSIONS
Prescription drug donation from corporate
entities to Ohio’s free clinics via the Ohio Drug
Donation Repository serves an important role in
maintaining the financial well-being of both the clinics
and the patients they serve. However, recent
consolidation in Ohio’s nursing home industry has
threatened the program’s viability. Medical students,
being vitally invested in the health of many of these
clinics, should monitor these developments, and
advocate for increased participation in the program.
10. Ohio Association of Free Clinics : Charitable
2
�Markle
JMS, May 2023—Volume 2, Issue 1
Healthcare Network. Accessed February 7, 2022.
https://www.charitablehealthcarenetwork.org/
20. CommunityCare Clinics. Accessed February 8,
2022. http://www.utcommunitycare.org/
11. Ohio Association of Free Clinics : Membership :
Our Members. Accessed February 7, 2022. https://
www.charitablehealthcarenetwork.org/
membership/our-members.html
21. Heritage Community Clinic | Ohio University.
Accessed February 8, 2022. https://www.ohio.edu/
medicine/community-health/community-clinic
22. Home | Student Run Health Clinic. Accessed
February 8, 2022. https://case.edu/srhc/
12. Millions of dollars of life-saving drugs being
destroyed in Ohio rather than donated to
voluntary program. WEWS. Published April 6,
2019. Accessed February 7, 2022. https://
www.news5cleveland.com/news/local-news/
investigations/millions-of-dollars-of-life-savingdrugs-being-destroyed-in-ohio-rather-thandonated-to-voluntary-program
23. Student Run Free Clinic | Northeast Ohio Medical
University. NEOMED. Accessed February 8, 2022.
https://www.neomed.edu/student-run-free-clinic/
ACKNOWLEDGMENTS
13. Prescription Assistance Program in Lake County
seeking clients. News-Herald. Published August 5,
2021. Accessed February 7, 2022. https://
www.news-herald.com/2021/08/05/prescriptionassistance-program-in-lake-county-seeking-clients
None
CONFLICTS OF INTEREST
14. Yu R. CVS buys Omnicare for $12.7B to expand
senior care business. USA TODAY. Accessed
February 7, 2022. https://www.usatoday.com/story/
money/2015/05/21/cvs-health-buysomnicare/27702707/
Mr. Markle currently serves as the medical student
representative on the Ohio State Medical
Association’s (OSMA) Political Action Committee
(PAC). He is the primary author of OSMA Policy
16—2020, designed to increase private and publicsector awareness of the Ohio Drug Donation
Repository and the free clinics it serves. No
financial support was given to aid the writing of
this article.
15. Research C for DE and. Drug Supply Chain
Security Act (DSCSA). FDA. Published February
3, 2022. Accessed February 7, 2022. https://
www.fda.gov/drugs/drug-supply-chain-integrity/
drug-supply-chain-security-act-dscsa
AUTHOR CONTRIBUTIONS
16. Section 3715.872 - Ohio Revised Code | Ohio
Laws. Accessed February 7, 2022. https://
codes.ohio.gov/ohio-revised-code/section-3715.872
Background Research: JM
Manuscript Preparation: JM
Manuscript Review: JM
17. Xu J. Letting Medical Students Run the Clinic. The
Atlantic. Published November 12, 2013. Accessed
February 8, 2022. https://www.theatlantic.com/
health/archive/2013/11/letting-medical-studentsrun-the-clinic/281241/
18. Simpson SA, Long JA. Medical student-run health
clinics: important contributors to patient care and
medical education. J Gen Intern Med. 2007;22
(3):352-356. doi:10.1007/s11606-006-0073-4
19. Community Service | Ohio State College of
Medicine. Accessed February 8, 2022. https://
medicine.osu.edu/why-choose-us/campus-life/
community-service
3
�
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Title
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Journal of Medical Sciences at NEOMED (Vol2Issue1)
Volume 2 Issue 1 - February 2023
Publisher
An entity responsible for making the resource available
Journal of Medical Sciences at NEOMED
Date
A point or period of time associated with an event in the lifecycle of the resource
February 2023
Description
An account of the resource
The Journal of Medical Sciences at NEOMED is an online, student-led, peer-reviewed scholarly journal created to provide a platform for NEOMED students, faculty and affiliates to publish original research, opinion pieces, editorials, reviews, abstracts and other works.
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
n/a
Pages
1-3
Volume
2
Issue
1
Author(s) ORCID iD
n/a
NEOMED College
College of Medicine
NEOMED Department
NEOMED Student Publications
Affiliated Hospital
n/a
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Article information provided for research and reference use only. All rights are retained by the Journal of Medical Sciences at NEOMED.
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Title
A name given to the resource
Prescription Drug Donation and the Private Sector—Why Ohio’s Medical Students Should Care
Creator
An entity primarily responsible for making the resource
Markle J
Publisher
An entity responsible for making the resource available
Journal of Medical Sciences at NEOMED
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Subject
The topic of the resource
prescriptions; prescription donation; drug depository; free clinics
Description
An account of the resource
This perspective piece discusses the important role donation of prescription medication from the private sector plays in the financial health of Ohio’s free clinics and the patients they serve. It also discusses recent changes in Ohio’s nursing home industry that have altered this vital pipeline, why medical students should care about them, and a personal anecdote from the author about the impact these changes can have on patients.
Identifier
An unambiguous reference to the resource within a given context
n/a
-
https://d1y502jg6fpugt.cloudfront.net/44177/archive/files/30de7eb7a44c8176fffdfd4ccb8e47ff.pdf?Expires=1712793600&Signature=XrsrKJtGd2AKqkSk1zDRF1MeL3YUPEkxC6fpvNKuL-X0Q2KPu1H8lun5jxxh7xXIJzMWzfks7uH9%7EcrxoglflHewFnZt9apitDg--fBHZJVBG-2M8skRWwGgVI3Pj6McfhpsYYLNkP9olD9anbWB7jo1R0PuVijz5q3741NFgKj4T-hQ20M-N3JWpjhZwIkEIL6yRBPql001GReDljqWD0LwOOufEoFi7Oy0zOMv55W6heTRmZVcYYO1rogoYR%7EgpF-IJf20135KV0ApNBPweZuuQzGXOBiSrAB4Jdel%7Ea6nOFh65vBvbqV8TMaRA9iGy9QtqekYBB-00nuT9fT-MQ__&Key-Pair-Id=K6UGZS9ZTDSZM
a675ff48581ad5f373e8cd8d19893dac
PDF Text
Text
Journal of Medical Sciences at NEOMED
Volume 2, Issue 1, May 2023
Comparison of the Wellness of a Medical School to General Student Population
Amy Adik, BS1, Sanjay K.A. Jinka, BS1, Christian Seif, BS1, Theodore Weber, BS1, Anika A.
Jinka1, Randon S. Welton, MD1
1.
Department of Psychiatry, College of Medicine, Northeast Ohio Medical University, Rootstown, OH, 44272
ABSTRACT
When compared to the general population, healthcare students have been shown to have significantly
higher rates of burnout, depression, anxiety, and suicidal ideation. However, there is limited data
regarding mental health, access to mental health resources, and utilization of mental health resources by
healthcare students in comparison to other student populations. This study aims to evaluate a medical
university’s mental health and access/utilization of resources when compared to the general student
population. Survey results from The Healthy Minds Study (HMS) of Northeast Ohio Medical University
(NEOMED) students were compared to a national sampling of graduate and post-graduate student
populations. Categories that were assessed included mental health status (previous diagnosis, depression/
anxiety related symptoms experienced recently or within the past 12 months) and access/utilization of
resources (support system, use of psychotropic medications). Analysis was completed through individual
Chi-squared tests. Compared to the national sample NEOMED students were less likely to talk to a
professional clinician (p=0.017), friend (p=0.001), significant other (p=0.009), or family member
(p=0.001) about distress and were less likely to be on anti-anxiety medications (p=0.018). NEOMED
students were less likely to be unsure of where to go for help (p=0.009) while preferring to deal with
issues on their own (p=0.001); NEOMED students were less likely to report a history of depression
(p=0.044) or anxiety (p=0.028). NEOMED students were more likely to have no days of the week be
impacted by mental difficulties (p=0.005), and NEOMED students were more likely to strongly disagree
that they were in need of help for their mental state (p=0.047). Despite the intensity of healthcare training,
this survey showed that students at NEOMED were no worse than the general student population in terms
of access and utilization of mental health resources and mental functioning. The data suggest that
NEOMED students are more reluctant to seek help but may have fewer mental health issues compared to
other student populations.
Keywords: mental health, students
INTRODUCTION
lead to a potential decline in students’ mental and
emotional well-being.1
Most of the data in healthcare education comes
from the training of medical students. Even though
many medical schools strive to support students, data
show that distress is common among these students.1
About 50% of US medical students report symptoms of
burnout and 11% acknowledge recent suicidal ideation.2
In addition, depression rates are seen to be higher in
medical students than the general population.3 Anxiety
is less studied in the medical student population but also
seems higher than in the general public.4 Substance use
is prominent in medical students with one third of
students demonstrating high risk alcohol consumption. 4
Substance use may contribute to the depression
and anxiety seen in medical students.1,3 Perhaps because
of the ongoing stigma associated with mental illness,
medical students are less likely to seek treatment
Northeast
Ohio
Medical
University
(NEOMED) includes a College of Medicine, College of
Pharmacy, and a College of Graduate Studies which
focus on healthcare related programming. The vision of
the University is to be the model of excellence in
innovative education and impactful research to create
transformational healthcare leaders. Currently about
60% of NEOMED students are in the College of
Medicine, 30% in the College of Pharmacy, and 10% in
the College of Graduate Studies.
Healthcare education in the United States aims
to develop graduates who are competent, empathetic,
and strive for excellence when treating the sick or
making advances in the medical field.1 Healthcare
education is academically and emotionally draining,1
and there is growing recognition that those demands
1
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Demographic
NEOMED
Survey (n=274)
General Student Survey
(n=103,748)
Gender
Male
39%
39%
Female
60%
58%
Other
1%
3%
African American/Black
6.12%
17%
American Indian or Alaskan Native
0.68%
2%
Asian American/Asian
26.53%
11%
Hispanic/Latin(x)
3.40%
12%
Native Hawaiian or Pacific Islander
0.34%
1%
Middle Eastern, Arab, or Arab American
7.48%
2%
White
54.08%
63%
Self-identify (please specify)
1.36%
2%
25.23
23.38
Race
Mean Age
Table 1. Survey Demographics
compared to the general population.3
It is not clear how much of this worsening
mental health and wellness is due to general stresses
associated with higher education as opposed to
healthcare education in particular. Maser et. al.
compared medical students’ mental health with
similarly aged postsecondary graduates in Canada and
found that medical students had significantly higher
rates of anxiety, suicidal ideation, and psychological
distress (p-value < 0.001).5 There is minimal literature
regarding mental health, access to mental health
resources, and utilization of mental health resources by
healthcare students in comparison to other student
populations. This study aims to fill this gap by
evaluating a rural medical university’s mental health
and access/utilization of resources when compared to a
national student population in the United States. These
findings will help the university understand how to
better adapt current university mental health resources
for healthcare students in particular. Failure to do so can
result in the continued growth of the many
consequences of mental distress among healthcare
students, including having a negative impact on a
student’s journey to becoming a proficient provider,
increased unprofessional behavior, and decreased
empathy, all of which can possibly lead to the burnout. 6
METHODS
This project was based on the results of the
2021 Healthy Minds Study (HMS) – an anonymous
web-based survey.7 Students were invited by their
university to participate and were reminded via emails,
which contained a URL that students used to gain
access to the survey. The HMS upheld the privacy and
confidentiality of participants and was also protected by
a Certificate of Confidentiality from the National
Institutes of Health.7
2
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Figure 1. Emotional support sources among medical school students compared to all higher education students
The HMS was designed to examine mental
health and related issues in college level student
populations.7 NEOMED’s use of this data was to
identify needs and priorities and to plan for services and
programs. Our study compared NEOMED’s survey
results from the spring – summer of 2021 to the results
of various undergraduate and postgraduate student
populations from 2020 to 2021. The survey was
anonymous, and there was no compensation for
participating.
Categories that were analyzed included mental
health status (previous diagnosis, depression/anxiety
related symptoms experienced recently or within the
past 12 months) and access/utilization of resources
(support system, use of psychotropic medications).
These results compared the 103,748 students that
participated in the HMS national survey, with the 274
students that participated in the NEOMED survey.
All statistical analyses (chi-squared) were
carried out using STATA (13MP) with a significance
level of p<0.05.
IRB approval for this analysis was not sought
as the survey had been previously conducted and
published.
Demographics
RESULTS
The national HMS had 103,748 participants
including the 274 students at NEOMED. This yielded
an approximate participation rate of 15% for the
national survey and 27% at NEOMED. The majority
(64%) of respondents in the general HMS survey were
pursuing a bachelor’s degree, while the majority (68%)
of respondents in the NEOMED survey was pursuing a
medical degree. Of the other respondents in the general
population, 18% were pursuing an associate degree,
11% master’s degrees, and only 1% medical degrees.
Thirty percent of the NEOMED respondents were
pursuing a pharmacy degree and 2% were pursuing
other graduate degrees. See Table 1 for a summary of
demographics in each survey sample.
3
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Figure 2. Prescription medication use among medical school students compared to all higher education
Emotional Support
Prescription medications
When asked “If you were experiencing serious
emotional distress, whom would you talk to about this,”
NEOMED students were most likely to seek support
from a friend or family member (44% total), but this
was at roughly half the rate of their general student
counterparts (86% total). NEOMED students were
significantly less likely to seek support from a
professional clinician, friend (not roommate),
significant other, or family member (p-values = 0.02,
0.00, 0.01, and 0.00, respectively). (Figure 1)
When asked “In the past 12 months have you
taken any of the following types of prescription meds
(several times per week minimum),” NEOMED
students were significantly less likely to report having
taken anti-anxiety medications (p-value = 0.02). Only
19% reported having taken antidepressants, but this was
not statistically different than the 26% of general
students who reported having taken antidepressants.
(Figure 2)
Barriers for mental health services
When asked “In the past 12 months, which of
the following factors have caused you to receive fewer
4
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Figure 3. Barriers for mental health services among medical school students compared to all higher education students
services (counseling, therapy, or medications) for your
mental or emotional health than you would have
otherwise received? (Select all that apply),” 13% of
NEOMED respondents claimed they had no need for
services, 4% that they were not sure where to go, and
7% that they preferred to deal with issues on their own
or with personal support networks. These were all
significantly less frequent than in the general student
population (p-values = 0.00, 0.01, 0.00, respectively).
(Figure 3)
“none” than the general student population (28% vs
17%, p = 0.01). (Figure 4)
Current need for mental health support
When asked about their agreement with the
statement “I currently need help for emotional or mental
health problems such as feeling sad, blue, anxious or
nervous,” NEOMED students were significantly more
likely to select “Strongly Disagree” than were general
students (p = 0.04), but the rates were low (6% vs 3%).
(Figure 5)
Mental health affecting academic performance
When asked “In the past 4 weeks, how many
days have you felt that emotional or mental difficulties
have hurt your academic performance,” NEOEMD
students were significantly more likely to respond
Previous mental health diagnosis
When asked if respondents had previous
diagnoses of mental health disorders, significantly fewer
NEOMED students reported having a history depression
5
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Figure 4. Mental health’s effects on academic performance among medical school students compared to all higher
education students
(17% vs 28%) or anxiety (19% vs 31%) when compared
to the general population (p-values =0.04 and 0.03,
respectively). (Figure 6)
Apart from the public stigma, NEOMED
students are also less willing to turn to family and
friends for support. This might imply that the hesitation
is at least partly due to wanting to maintain an image of
being able to cope with life’s stresses or needing to
maintain a self-image of strength and undiminished
ability. Often, help-seeking and time off can be
perceived as weakness or poor work ethic in a
competitive medical community that emphasis success
and productivity.10 This perception is supported by
results of our study. In Table 4, the most common
reason given for not seeking services was related to “not
enough time.” Fear of being depicted as unproductive or
unambitious could be leading students to avoid
appropriate treatment.
Our study also found that NEOMED students
report taking fewer psychotropic medications than the
general student population. This may be due to a variety
of factors. Firstly, NEOMED students may be underreporting their medication use. Secondly, healthcare
students might place a lot of pressure upon themselves
to put on a public façade of toughness and perfection.
The self-imposed expectation to be flawless leaves
students feeling as if they are frequently falling short,
which places significant strain on their mental health. 11
The use of prescription medications to improve mental
health would undermine the image that the students are
trying to forge. The need to maintain this façade may
DISCUSSION
The findings in this study suggest that
NEOMED students are less likely to seek emotional
support in times of distress when compared to the
general undergraduate / graduate student population. A
possible explanation for this is that students in
healthcare specialties are uniquely hesitant to disclose
mental health issues or the need for mental health
treatment.8 This could partially stem from the stigma of
having a mental illness or seeking treatment. There
might also be the belief that depression and anxiety are
an expected part of medical training, and they may need
to learn how to manage it on their own. This fear of
disclosure could cause students to shy away from
needed help. For healthcare students, there could also be
the fear that seeking such treatment might have a
negative impact on their career and make them less
competitive for future training positions or future
employment. A study at the University of New Mexico
School of Medicine revealed that 51% of students at the
University stated they would not disclose a previous
mental health diagnosis on a New Mexico Medical
Board license application.9
6
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Figure 5. Current need for mental health support among medical school students compared to all higher education
students
both worsen their distress and prevent them from
seeking the help necessary to alleviating the distress.
Healthcare training should place an emphasis on
embracing vulnerability in students and allowing them
to understand that perfection is unachievable and asking
for help is admirable.
The findings in this study also suggest that
NEOMED students are less likely to report previous
formal diagnoses of mental health disorders. It could be
posited that this is due to admission of students without
previous mental health conditions, but there has been no
significant research into this subject. Denying their own
history of mental illness might also be in service of
maintaining a strong and capable self-image.
A large number of participants of the
NEOMED study were Asian students, however it is
unclear what impact that could have had on the results.
No significant previous research could be found that
could correlate Asian students baseline mental health in
comparison to all other students.
Further analysis into this subject is warranted,
as there is limited literature comparing the mental
health of medical students to other student populations.
Future research could be directed towards comparing
averaged responses from all medical schools in the
United States versus all graduate schools. Other studies
may be conducted after excluding undergraduate
students, to better account for age.
Students could feel more comfortable
accessing counseling services if counseling services
were destigmatized. One way to go about this would be
to see if any students who currently are undergoing
counseling would be willing to speak on their
experience and the benefit they have received from
counseling. This would allow students to feel more
comfortable in engaging in counseling themselves by
seeing that one of their peers received help. Another
way to help students feel more comfortable in accessing
counseling is to have a panel of counselors discuss with
the class what goes on during the counseling sessions.
This will give the students a better idea of what is
exactly entailed within counseling and will help them
become more aware if they have a need for counseling.
Taken together, these data point to a need for
mental health resources for students regardless of type
of school. On-campus behavioral health counselors are
common at the university level, but Kirsch et. al. goes
on to outline a more unique solution: student support
networks.12 These support groups, while simple and
inexpensive, harness the power of peer-to-peer
interventions to influence positive outcomes. A more
recent study from Naslund et. al. went on to show the
peer-to-peer support groups can be effective in
influencing positive changes even when these groups
only exist virtually through mediums such as social
media.13 These successes lead to us recommending
7
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
Figure 6. Previous mental health diagnoses among medical school students compared to all higher education students
universities facilitate peer support groups in both online
and in-person settings moving forward to help improve
student wellness.
This study has numerous limitations. Our data
is collected from one medical university in rural,
northeast Ohio. The data is also an aggregate of medical
students, pharmacy students, and graduate students. It is
possible that one or more of these groups responded in a
fashion distinctly different than the other(s). The results
are self-reported data and thereby influenced by
students’ willingness to report. Over-reporting on an
anonymous survey may not be likely, but it is certainly
possible that some students had previous histories of
mental illness or mental health treatment that they chose
not to report. The survey was distributed during the
COVID-19 pandemic, and it is unclear how those
stresses impacted the survey results. It is also unclear if
the pandemic impacted healthcare students differently
than general students. Another possible limitation to this
study is the relatively small sample size (274) in
comparison to the national data (103,748). A final
consideration is there might be significant differences in
the demographics of the NEOMED students compared
to the general student population that might have
skewed the data. These could include age, gender,
sexual orientation, race, and ethnicity. All of these
factors might have impacted the generalizability of our
data.
CONCLUSION
We used The HMS to compare students at
NEOMED to the general student population in terms of
access/utilization of mental health resources and mental
functioning. Our study found that NEOMED students
reported having fewer mental health issues and were
more reluctant to seek appropriate help when compared
to the general student population. Expanding our
8
�Adik et al.
JMS, May 2023—Volume 2, Issue 1
analysis of the HMS to include multiple medical
schools can lead to more generalizable findings.
9.
REFERENCES
1.
Fletcher I, Castle M, Scarpa A, Myers O,
Lawrence E. An exploration of medical student
attitudes
towards
disclosure
of
mental
illness. Med Educ Online. 2020;25(1):1727713.
doi:10.1080/10872981.2020.1727713
Quek TT, Tam WW, Tran BX, Zhang M, Zhang
Z, Ho CS, Ho RC. The Global Prevalence of
Anxiety Among Medical Students: A MetaAnalysis. Int J Environ Res Public Health.
2019;16(15):2735. doi:10.3390/ijerph16152735
10. Stergiopoulos E, Fragoso L, Meeks LM. Cultural
Barriers to Help-Seeking in Medical Education. JAMA
Intern Med. 2021;181(2):155-156. doi:10.1001/
jamainternmed.2020.7567
2.
Dyrbye LN, Thomas MR, Massie FS, et al.
Burnout and suicidal ideation among U.S. medical
students. Ann Intern Med. 2008;149(5):334-341.
doi:10.7326/0003-4819-149-5-200809020-00008
11. Yanes AF. The Culture of Perfection: A Barrier
to Medical Student Wellness and Development.
Acad Med. 2017;92(7):900-901. doi:10.1097/
ACM.0000000000001752
3.
Givens JL, Tjia J. Depressed medical students' use
of mental health services and barriers to use. Acad
Med. 2002;77(9):918-921. doi:10.1097/00001888200209000-00024
4.
Ketoja J, Svidkovski AS, Heinälä P, Seppä K.
Risky drinking and its detection among medical
students. Addict Behav. 2013;38(5):2115-2118.
12. Kirsch DJ, Pinder-Amaker SL, Morse C, Ellison
ML, Doerfler LA, Riba MB. Population-based
initiatives in college mental health: students
helping students to overcome obstacles. Curr
Psychiatry Rep. 2014;16(12):525. doi:10.1007/
s11920-014-0525-1
5.
6.
7.
8.
13. Naslund JA, Aschbrenner KA, Marsch LA,
Bartels SJ. The future of mental health care: peerto-peer support and social media. Epidemiol
Psychiatr Sci. 2016;25(2):113-122. doi:10.1017/
S2045796015001067
Maser B, Danilewitz M, Guérin E, Findlay L,
Frank E. Medical Student Psychological Distress
and Mental Illness Relative to the General
Population: A Canadian Cross-Sectional Survey.
Acad Med. 2019;94(11):1781-1791. doi:10.1097/
ACM.0000000000002958
ACKNOWLEDGEMENTS
Dyrbye LN, Harper W, Moutier C, Durning SJ,
Power DV, Massie FS, Eacker A, Thomas MR,
Satele D, Sloan JA, Shanafelt TD. A multiinstitutional study exploring the impact of positive
mental health on medical students' professionalism in
an era of high burnout. Acad Med. 2012;87(8):10241031. doi:10.1097/ACM.0b013e31825cfa35
No acknowledgements
CONFLICTS OF INTEREST
All authors declare no conflicts of interest.
Eisenberg D, Lipson SK, Heinze J. The Healthy
Minds Study: 2021 Winter/Spring Data Report.
Health
Minds
Network.
2021.
https://
healthymindsnetwork.org/wp-content/
uploads/2022/01/HMS_nationalwinter2021_update1.5.21.pdf
AUTHOR CONTRIBUTIONS
Data Collection: AA, SJ, CS, TW, AJ, RW
Data Analysis: AA, SJ, CS, TW, AJ, RW
Shahaf-Oren B, Madan I, Henderson C. A lot of
medical students, their biggest fear is failing at
being seen to be a functional human: disclosure
and help-seeking decisions by medical students
with health problems. BMC Med Educ. 2021;21
(1):599. doi:10.1186/s12909-021-03032-9
Manuscript Preparation: AA, SJ, CS, TW, AJ, RW
Manuscript Review: AA, SJ, CS, TW, AJ, RW
9
�
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Title
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Journal of Medical Sciences at NEOMED (Vol2Issue1)
Volume 2 Issue 1 - February 2023
Publisher
An entity responsible for making the resource available
Journal of Medical Sciences at NEOMED
Date
A point or period of time associated with an event in the lifecycle of the resource
February 2023
Description
An account of the resource
The Journal of Medical Sciences at NEOMED is an online, student-led, peer-reviewed scholarly journal created to provide a platform for NEOMED students, faculty and affiliates to publish original research, opinion pieces, editorials, reviews, abstracts and other works.
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URL Address
n/a
Pages
1-9
Volume
2
Issue
1
Author(s) ORCID iD
n/a
NEOMED College
College of Medicine
NEOMED Department
NEOMED Student Publications
Affiliated Hospital
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Title
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Comparison of the Wellness of a Medical School to General Student Population
Creator
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Adik A; Jinka SK; Seif C; Weber T; Jinka AA; Welton RS
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Journal of Medical Sciences at NEOMED
Date
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2023
Subject
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mental health; students
Description
An account of the resource
When compared to the general population, healthcare students have been shown to have significantly higher rates of burnout, depression, anxiety, and suicidal ideation. However, there is limited data regarding mental health, access to mental health resources, and utilization of mental health resources by healthcare students in comparison to other student populations. This study aims to evaluate a medical university’s mental health and access/utilization of resources when compared to the general student population. Survey results from The Healthy Minds Study (HMS) of Northeast Ohio Medical University (NEOMED) students were compared to a national sampling of graduate and post-graduate student populations. Categories that were assessed included mental health status (previous diagnosis, depression/ anxiety related symptoms experienced recently or within the past 12 months) and access/utilization of resources (support system, use of psychotropic medications). Analysis was completed through individual Chi-squared tests. Compared to the national sample NEOMED students were less likely to talk to a professional clinician (p=0.017), friend (p=0.001), significant other (p=0.009), or family member (p=0.001) about distress and were less likely to be on anti-anxiety medications (p=0.018). NEOMED students were less likely to be unsure of where to go for help (p=0.009) while preferring to deal with issues on their own (p=0.001); NEOMED students were less likely to report a history of depression (p=0.044) or anxiety (p=0.028). NEOMED students were more likely to have no days of the week be impacted by mental difficulties (p=0.005), and NEOMED students were more likely to strongly disagree that they were in need of help for their mental state (p=0.047). Despite the intensity of healthcare training, this survey showed that students at NEOMED were no worse than the general student population in terms of access and utilization of mental health resources and mental functioning. The data suggest that NEOMED students are more reluctant to seek help but may have fewer mental health issues compared to other student populations.
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https://d1y502jg6fpugt.cloudfront.net/44177/archive/files/9da7e3ccf248d1e6865aca676bd7232d.pdf?Expires=1712793600&Signature=jdSM6i3nP-sl33EamyRBuGcHX7yX1PKYNSEmy0mkmR6Fa6JX7DwaI36-uAg-Acma%7E1ulc8am%7Eq4HZa38kXPsvlJslBZ0El8M5lZlmJvVDiHJ7UsYJ1aRTPEzB1kcS8gTsgZtAeXwXx4hFeNKiAzk1vozNi7fF6PyMd5SrzAPP6VdUCdXxBaVsd23JwigMZTFIJVsa2ulqD2ktyLfKTGSgM381csNbZ1DvPN0gV7qQqfSloRzet-VMOw0WEfOIUzP8QfHlKCZ8Ktj9trljEiB9KuUSyFMqhAMAw2ZYZNpK2P7blOHY4Fz44G%7EzsWQW9A6hQNSClXXvXOy68QyObbw9w__&Key-Pair-Id=K6UGZS9ZTDSZM
692026e83b0121c183ddabeddf012cda
PDF Text
Text
Journal of Medical Sciences at NEOMED
Volume 2, Issue 1, May 2023
The Law and Ethics of Non-beneficial Treatment Policies
Emily Marsico, BS1 and Julie M. Aultman, PhD1
1.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, 44272
ABSTRACT
A non-beneficial treatment is defined as when a physician decides that the patient’s prognosis of a medical
illness or injury, cannot be altered by a certain form of treatment. 1 No medical therapy can improve the
patient’s prognosis or condition. The ethics regarding non-beneficial treatment policies are of great debate
due to their lack of consistency between healthcare systems. This paper compares the non-beneficial
treatment policies between a hospital that operates under religious values and one that bases their values
on community and population health with no religious ties. These policies will be compared to the
guidelines put forth by the American Medical Association (AMA) Code of Medical Ethics, American
Thoracic Society (ATS), American Association for Critical Care Nurses (ACCN), American College of
Chest Physicians (ACCP), European Society for Intensive Care Medicine (ESICM), and Society of
Critical Care (SCCM). The purpose of this paper is to highlight how subjective these policies can be and
how their inconsistencies between hospital systems can lead to harmful patient outcomes.
Keywords: medical ethics, non-beneficial treatment, health care systems, health care law
INTRODUCTION
Society (ATS), American Association for Critical Care
Nurses (ACCN), American College of Chest Physicians
(ACCP), European Society for Intensive Care Medicine
(ESICM), and Society of Critical Care (SCCM). Nonbeneficial treatment guidelines were developed by
diverse panels of experts from these organizations
through collaboration and consensus on the core ethical
values centering on patient welfare.
The outcomes of cases such as, Cruzan v.
Director, Missouri Department of Health, 111 L.Ed.2d.
224 (S. Ct. 1990) and Betancourt v. Trinitas Hospital, 1
A.3d 823 (N.J. Super. 2010) are what created the
importance of non-beneficial treatment policies and
guidelines to be put in place at healthcare institutions.
Due to their significance in healthcare law and nonbeneficial treatment, these cases were chosen to be
analyzed. The outcome of Cruzan v. Director, Missouri
Department of Health was the Patient Self-Determining
Act (PSDA).3 The Betancourt v. Trinitas Hospital case
was one of the first cases that centered around the topic
of non-beneficial treatment. It also highlighted the need
of non-beneficial treatment policies in healthcare
institutions.
This essay compares the non-beneficial
treatment policies of a hospital that bases their values
on community and population health under religious
values, and one that bases their values on community
and population health with no religious ties. These
policies will be compared to the guidelines put forth by
Medical futility is when a physician decides
that the patient’s prognosis of a certain medical illness
or injury cannot be altered by a certain form of
treatment.1 No medical therapy can improve the
patient’s prognosis or condition. When a physician
analyzes the effect and benefit a treatment has on a
patient, these outcomes should be observed
independently of each other. The effect of a treatment is
the localized outcome that a patient experiences at a
certain part of the body.2 The benefit of a treatment is
the systemic response it provides the patient by
improving their health.2 If the medical treatment has no
benefit, regardless of if there were effects that elicited a
response from the patient, the treatment is futile.2 The
word futile should only be used for treatments that truly
elicit no benefit to the patient. In all other clinical
situations, the term non-beneficial treatment should be
utilized.2
There is no consistency of non-beneficial
treatment policies in the health care system. This causes
several lawful and ethical dilemmas within the field.
What is deemed a non-beneficial medical treatment can
vary from physician to physician.1 This can diminish
the consistency and guiding principles of what a nonbeneficial treatment is, set forth by the American
Medical Association (AMA), American Thoracic
1
�Marsico & Aultman
JMS, May 2023—Volume 2, Issue 1
the AMA Code of Medical Ethics, ATS, ACCN, ACCP,
ESICM, and SCCM. The AMA was the first
organization to publish a Code of Medical Ethics and is
the code that all physicians in the United States are
guided by when practicing medicine.4 The guidelines
put forth by the ATS, ACCN, ACCP, ESICM, and
SCCM are included in this paper because they were
developed through a collaborative approach that
included expert input and representation from each
committee listed.5 The purpose of this paper is to
highlight how subjective these policies can be and how
their inconsistencies between hospital systems can lead
to harmful outcomes patients.
about their health, have the right to:
(1) Decide if they want medical or surgical
intervention, including artificial nutrition and
hydration.
(2) Make advance directives.
(3) Decide on a surrogate to make decisions on their
behalf.3
To assess competency the individual must be
able to understand their current condition, communicate
their decision on how they want to proceed, and
understand the consequences, risks, and benefits of this
decision.7
BACKGROUND
The next case that is remarkable on the topic of
non-beneficial treatment, is that of Betancourt v.
Trinitas Hospital,1 A.3d 823 (N.J. Super. 2010). This
case highlights the importance of a standardized nonbeneficial treatment policy within healthcare systems.
Reuben Betancourt underwent a surgical procedure to
remove a malignancy from his thymus at the Trinitas
Hospital in New Jersey.8 Betancourt’s surgery was a
success; but while in the post-operative intensive care
unit, the tube providing oxygen to the patient became
dislodged.8 This caused Betancourt to be without
oxygen for some time, causing him to develop anoxic
encephalopathy, eventually leading to permanent
unconsciousness.8 In addition to this, the patient needed
to undergo dialysis weekly. He also developed
decubitus ulcers that later developed into osteomyelitis.
It was deemed by the hospital and the health care
providers on Betancourt’s case that any further
treatment of the patient would be non-beneficial and not
better than his current prognosis,8 thus upholding the
ethical principles of beneficence and non-maleficence.
The physicians placed a Do Not Resuscitate (DNR)
order in the patient’s chart. The plaintiff Jacqueline
Betancourt, the patient’s daughter, filed an action that
the hospital and physicians must continue to treat the
patient.8 The judge ruled in favor of the plaintiff and
required the hospital to reinstate treatment of
Betancourt.8 However, within three months of the
judge's order requiring reinstatement of treatment,
Betancourt passed away.8 The case ultimately ended on
a basis of mootness. This hallmark case established the
need for non-beneficial treatment policies in healthcare
institutions.
In Western medicine, before the principle of
autonomy was established, the patient-physician
relationship was characterized as more of a one-sided,
paternalistic relationship. Physicians, in the earlier and
mid decades of the 1900s, would determine the best
plan of care for a patient by themselves or with other
healthcare provider colleagues.2 Patient autonomy and
participation in health care was not required until the
PSDA was established in 1991.6 The PSDA states that if
a health-care institution wants to receive government
funding through Medicare or Medicaid, they must
inform their patients of the state laws governing selfdetermination issues.6 This law required physicians to
tell their patients that they have the right to refuse
medical treatment. It also established the requirement
that care plan discussions be facilitated among patients,
their physicians, and family members who are involved
in the well-being of the patient. According to the PSDA,
if the patient does not have an appointed surrogate to
make healthcare decisions on their behalf, the hospital
does not have the right to determine the type of
treatment the patient will receive.6 If a situation like this
is encountered, the hospital and physicians providing
the care should reach out to family members of the
patient to consult them about the next steps of care.6
The landmark case that provoked the
establishment of the PSDA and prompted a critical
ethical examination of the withdrawing of treatment,
was Cruzan v. Director, Missouri Department of Health,
111 L.Ed.2d. 224 (S. Ct. 1990). Nancy Cruzan was a 25
-year-old woman who, in 1983, got in a car accident
that caused her to be ejected out of her vehicle.3 Cruzan
remained in a rehabilitation hospital for three years after
the accident. It was later concluded by her physician
and family members that she would never regain full
consciousness.3 The family wanted to remove the life
support treatment from Cruzan, but since it was keeping
her alive, the hospital would not withdraw treatment
from the patient.3 The Cruzan v. Director, Missouri
Department of Health, 111 L.Ed.2d. 224 (S. Ct. 1990),
case lasted for eight years, before the Cruzan family
finally won, and the feeding tube could be removed
from the patient.3 The outcomes of this case ruled that
any adult patient who is competent to make decisions
GUIDELINES FOR NON-BENEFICIAL
TREATMENT POLICIES
The AMA, ATS, ACCN, ACCP, ESICM, and
SCCM established guidelines that help facilitate the
implementation of a non-beneficial treatment policy in a
hospital system. All sources should be utilized when
deciding if a medical treatment is beneficial for a
patient or not. When a patient is incapacitated and can
no longer make decisions about their treatment plan, it
is unethical to give complete authority to one
2
�Marsico & Aultman
JMS, May 2023—Volume 2, Issue 1
individual, whether it be the patient’s surrogate or the
treating physician.5 To ethically create a care plan for a
patient, it should be a collaborative team effort between
the care team and the patient’s family. If disagreements
arise about the appropriate action of care, a negotiation
must be conducted that brings in more expert
consultants.5
The AMA Code of Medical Ethics provides
guidelines to physicians when facing decisions about
withholding or withdrawing life-sustaining treatments.4
According to this code, the physician should first
review with the patient and their surrogate, the
individual’s advance directive or their values, goals for
care, and treatment preferences.4 Next, the physician
should be sure to document these preferences and
confirm the patient’s surrogate is identified and
recorded in the medical record.4 It is the physician’s
duty to provide all relevant health information and
treatment options to the patient, or surrogate, during the
decision-making process.4 For example, the physician
should discuss with the patient and/or surrogate the
option of initiating a treatment to determine its clinical
effectiveness for the patient.4 If the treatment does not
prove to be effective for the patient, it should be
withdrawn from the patient.4 It is important to reassure
the patient and surrogate that the patient will receive
appropriate medical care. Withdrawing medical
treatment does not mean stopping patient care. Lastly, it
is important that the physician consults with the ethics
committee of the heath care facility throughout the
patient care process.4 This is especially important when
the patient or surrogate and the physician cannot reach
agreement about whether to withdraw life-sustaining
treatment.4 The ethics committee should also be
consulted when there is no surrogate available to make
decisions on the behalf of the patient or the physician
believes that the surrogate is not making the appropriate
decision based on the values, goals of care, or treatment
preferences expressed by the patient.4
The ATS, ACCN, ACCP, ESICM, and SCCM
have developed four recommendations physicians
should use to resolve any conflict during the decisionmaking process.5 The first recommendation is that
health care institutions should be proactive in
preventing intractable treatment conflicts.5 This
includes early communication and intervention between
the physician, patient, surrogate, and relevant expert
consultants.5 Communication is the most important part
of any decision-making process. Evidence suggests that
most disagreements between the provider and surrogate
can be resolved through further communication about
what exactly the treatment goals are for each party.
Outside help from expert consults, such as ethics or
palliative care consultants, can also help the resolution
process.5
The second recommendation is the term
“futile” should not be used to describe treatment options
that have the potential to achieve the therapeutic goals
the patient is seeking.5 The term that should be used to
describe such a treatment is “non-beneficial.” If the
family or surrogate of the patient does not agree with
the decision of a non-beneficial treatment, the next steps
then for the care management of the patient would be
to:
(1) Seek expert consultation to help the physician and
surrogate negotiate a solution to the disagreement.
(2) The surrogate can obtain a second opinion from an
outside provider.
(3) The surrogate can have the patient’s case reviewed
by the designated hospital committee that handles
non-beneficial treatment cases.
(4) The surrogate should be offered the choice to
transition the care of the patient to a different
medical hospital or team.
(5) If the treatment plan is negotiated, the decision
between the surrogate and the physician should
then be implemented.5
The third recommendation is that physicians
should refuse to give care to patients whose surrogates
request futile interventions.5 As stated above, the word
futile should never be used in the clinical setting.
However, if a medical treatment is truly futile, based off
the definition provided above, it is unethical for a
physician to provide this form of care upon a
surrogate’s request.2
The last recommendation provided by the
ATS, ACCN, ACCP, ESICM, and SCCM is, health care
providers should advocate for policies and laws that
address the issues pertaining to non-beneficial treatment
and when life-prolonging care should not be used.5 The
most important part about non-beneficial treatment
policies is to ensure that they are consistent. This
consistency should not only be maintained from
hospital to hospital, but from patient to patient. Having
a clear, consistent non-beneficial treatment policy in
place would limit the conflict between the provider and
the surrogate, therefore allowing more time to be spent
on treating the patient.
COMPARISON OF POLICIES
From this point, this paper will analyze and
compare the non-beneficial treatment policies between
two different healthcare systems. A comparison
between the policy of a secular hospital system and a
religious hospital system will be made to highlight the
differences between them. One such hospital system
that focuses on community-based health with no
religious ties, is a hospital system in Akron, OH. In
their policy, the steps that are laid out should only be
considered if there is a disagreement between the
surrogate and the physician regarding the care plan.
The first step that must be followed when a
physician becomes aware of disagreement about the
care plan is to schedule a meeting with all parties to
address the discrepancies between them. In a
conversation with Julie Aultman, PhD (Oct 16th, 2021),
she stated that the goal of this meeting would be to
3
�Marsico & Aultman
JMS, May 2023—Volume 2, Issue 1
to comply with their treatment requests within 14 days. 9
It is the physician’s responsibility to give full
authority to the surrogate or patient when it comes to
any decision-making regarding the care plan.9
Therefore, within the 14-day window the physician
must provide life-sustaining care that the patient or
surrogate requested. After the 14-day period, if there is
still conflict about the care plan and the physician has
yet to identify another physician that will fulfill the
patient or the surrogate’s request, the physician does not
have to provide the treatment that the physician has
determined to be medically or ethically inappropriate. 9
discuss what exactly the goals of care are for the patient
regarding their medical condition and prognosis. The
physician should explain all treatment options to the
patient or surrogate and why some options could be
deemed non-beneficial.
The next part of the policy outlines how
different consulting parties should be utilized while
developing a specific care plan for the patient. If the
physician feels that it is necessary, they can request a
palliative care consult to review the care plan. This
consult will review the patient’s case and decide if the
care plan is appropriate for a particular patient (Julie
Aultman, PhD, conversation, Oct 16th, 2021). If there is
disagreement between the consult and the physician, an
ethics committee consult should be brought into the
discussion. A second opinion from another physician
can also be utilized to resolve any conflict between
parties. This physician should not know about the case
and should have no significant relationship with the
physician in charge of implementing the non-beneficial
treatment process on the patient. In addition to this, the
patient/surrogate should be made aware that they are
given a minimum of 48 hours to pursue a second
opinion/transfer if they do not agree with the physician
that is a part of the care team for the patient. If
consultation and second opinions from other physicians
does not resolve the discrepancies between parties and
the care plan, this is when the ethics committee will step
in. The ethics committee will do their own investigation
and determine the next best steps for the patient. If there
is still no resolution after three business days, the
physician has an obligation to go through with their
treatment plan (Julie Aultman, PhD, conversation, Oct
16th, 2021).
When it comes to the non-beneficial treatment
policy of a religious system in Midlothian, VA, they
follow the Virginia Code Provisions and Regulations.
Under Virginia Law, every hospital that has the
facilities to provide life-sustaining treatments must have
a non-beneficial treatment policy.9,10 This policy must
include the processes that the physician and the
surrogate must go through for:
DISCUSSION
Overall, when comparing the two nonbeneficial treatment policies, there are major differences
in how they relate to one another and the guidelines put
forth by the AMA, ATS, ACCN, ACCP, ESICM, and
SCCM. The secular hospital system in Akron’s policy
follows more closely with the guidelines put forth by
the AMA, ATS, ACCN, ACCP, ESICM, and SCCM.
The policy is structured to facilitate communication
between all relevant parties, such as the patient,
surrogate, physician, ethics committee, and palliative
care team. When it comes to the non-beneficial
treatment policy of the religious hospital system in
Virginia, it ignores the autonomy of the patients and is a
lot more authoritative in nature. Although their policy is
based off state law, it has many religious values
associated with the policy. These values include the
banning of euthanasia, and the requirement to provide
life-sustaining treatment for a two-week period.10
The non-beneficial treatment policy of the
secular hospital system gives a step-by-step guide of
how to resolve conflict between the surrogate/patient
and the physician regarding the care plan. It also
highlights the most important part of any non-beneficial
utilization
plan,
which
is
communication.
Communicating between interdisciplinary fields is the
key to deciding what the best plan of action is for a
particular patient. It also ensures that physicians tell the
patient or surrogates exactly what their options are in
terms of finding a second opinion and how they can
maintain their own autonomy. The policy strives to
ensure the treatment plan process is collaborative and
no one individual has authority over another. It also
ensures that all parties can maintain their autonomy.
The non-beneficial treatment policy of the
hospital system in Virginia states that the physician
must follow the care plan put forth by the patient or
surrogate for 14 days even if the physician disagrees
with it. There is little room for collaborative decision
making for the treatment plan of a patient because of the
law stating that the decision-making authority is given
to the surrogate or patient. The physician can only state
their opinions about why they feel a medical treatment
would be non-beneficial. This policy does not really
follow the collaborative nature that the guidelines put
forth by the AMA and ATS suggest.
(1) Obtaining a second opinion regarding the medical
and ethical implications of a treatment plan and
why they are deemed non-beneficial to the patient.
(2) How to propose to an interdisciplinary ethical
committee that a medical treatment is ethically
inappropriate to implement on a patient.9
The only reason a physician might not have to
follow the set forth law, is if they refuse to follow the
advanced directive put forth by the patient or the
decision made by the surrogate.9 Any form of mercy
killing or euthanasia is also prohibited. If a physician
does deem that a patient’s or surrogate’s request for a
treatment is ethically or medically inappropriate, they
must explain to the individual why it is not ethical for
them to allow treatment to occur. They then should help
the surrogate or patient find a physician that is willing
4
�Marsico & Aultman
JMS, May 2023—Volume 2, Issue 1
CONCLUSION
Although there are guidelines that have been
published by relevant societies, such as the AMA, ATS,
ACCN, ACCP, ESICM, and SCCM, there is still no
consistency between non-beneficial treatment plans.
The importance of a consistent non-beneficial treatment
policy is to ensure that both the physician and patient
can maintain their autonomy in situations where critical
decisions need to be made. Consistent guidelines will
also allow for better collaborative decision making
between parties, so no one party has complete authority
over another. It could also stop some of the demands of
transferring patients to hospitals to receive care from
physicians that are willing to treat them. Ultimately, a
non-beneficial treatment policy ensures decisions are
being made in a timely matter, which limits any harm
the patient may experience throughout the process. For
guidelines of non-beneficial treatment to become
universal in the United States health care system, there
must be further development of shared policies for
secular and religious hospital systems at the regional
and national level.
Bernat
JL.
Medical
futility:
definition,
determination, and disputes in critical care.
Neurocrit Care. 2005;2(2):198-205. doi:10.1385/
NCC:2:2:198
2.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical
futility: its meaning and ethical implications. Ann
Intern Med. 1990;112(12):949-954. doi:10.7326/0003
-4819-112-12-949
3.
Cruzan v. Director, Missouri Department of
Health.497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d
224. June 25th, 1990.
4.
American Medical Association. Withholding or
withdrawing life-sustaining treatment. American
Medical Association: Ethics. Accessed Dec 15,
2021. https://www.ama-assn.org/delivering-care/
ethics/withholding-or-withdrawing-life-sustainingtreatment.
Appelbaum PS. Clinical practice. Assessment of
patients' competence to consent to treatment. N
Engl J Med. 2007;357(18):1834-1840. doi:10.1056/
NEJMcp074045
8.
Betancourt v. Trinitas Hospital in New Jersey. 415
N.J., Super 301, 1 A.3d 823. 2010.
9.
Virginia’s Legislative Information System. Code of
Virginia: § 32.1-127. Regulations. 2022. Accessed
Oct 17, 2021. https://law.lis.virginia.gov/vacode/
title32.1/chapter5/section32.1-127/.
10. Chakraborty R, El-Jawahri AR, Litzow MR,
Syrjala KL, Parnes AD, Hashmi SK. A systematic
review of religious beliefs about major end-of-life
issues in the five major world religions. Palliat
Support Care. 2017;15(5):609-622. doi:10.1017/
S1478951516001061
ACKNOWLEDGMENTS
REFERENCES
1.
7.
I would like to thank Dr. Daniel Grossoehme who
serves at Akron Children’s Hospital Medical Center
as a Staff Scientist at the Haslinger Family
Palliative Care Center. His expertise in palliative
and spiritual care, mixed methods research, and
policy were invaluable.
CONFLICTS OF INTEREST
All authors declare no conflicts of interest.
AUTHOR CONTRIBUTIONS
5.
Bosslet GT, Pope TM, Rubenfeld GD, et al. An
Official ATS/AACN/ACCP/ESICM/SCCM Policy
Statement: Responding to Requests for Potentially
Inappropriate Treatments in Intensive Care
Units. Am J Respir Crit Care Med. 2015;191
(11):1318-1330. doi:10.1164/rccm.201505-0924ST
6.
Koch KA. Patient Self-Determination Act. J Fla
Med Assoc. 1992;79(4):240-243.
Literature Review: EM
Manuscript Preparation: EM, JA
Review: JA, BH
5
�
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Title
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Journal of Medical Sciences at NEOMED (Vol2Issue1)
Volume 2 Issue 1 - February 2023
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Journal of Medical Sciences at NEOMED
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February 2023
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Title
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The Law and Ethics of Non-beneficial Treatment Policies
Creator
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Marsico E; Aultman JM
Publisher
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Journal of Medical Sciences at NEOMED
Date
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2023
Subject
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medical ethics; non-beneficial treatment; health care systems; health care law
Description
An account of the resource
A non-beneficial treatment is defined as when a physician decides that the patient’s prognosis of a medical illness or injury, cannot be altered by a certain form of treatment.1 No medical therapy can improve the patient’s prognosis or condition. The ethics regarding non-beneficial treatment policies are of great debate due to their lack of consistency between healthcare systems. This paper compares the non-beneficial treatment policies between a hospital that operates under religious values and one that bases their values on community and population health with no religious ties. These policies will be compared to the guidelines put forth by the American Medical Association (AMA) Code of Medical Ethics, American Thoracic Society (ATS), American Association for Critical Care Nurses (ACCN), American College of Chest Physicians (ACCP), European Society for Intensive Care Medicine (ESICM), and Society of Critical Care (SCCM). The purpose of this paper is to highlight how subjective these policies can be and how their inconsistencies between hospital systems can lead to harmful patient outcomes.
Identifier
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n/a
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URL
10.1016/j.jlr.2023.100361
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Title
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Identification of bile acid-CoA:amino acid N-acyltransferase as the hepatic N-acyl taurine synthase for polyunsaturated fatty acids
Creator
An entity primarily responsible for making the resource
Samuel A J Trammell
Luke F Gamon
Kamil Gotfryd
Katja Thorøe Michler
Bandar D Alrehaili
Iben Rix
Filip K Knop
Pontus Gourdon
Yoon-Kwang Lee
Michael J Davies
Matthew P Gillum
Trisha J Grevengoed
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
N-acyl taurines (NATs) are bioactive lipids with emerging roles in glucose homeostasis and lipid metabolism. The acyl-chains of hepatic and biliary NATs are enriched in poly-unsaturated fatty acids (PUFAs). Dietary supplementation with a class of PUFAs, the omega-3 fatty acids, increases their cognate NATs in mice and humans. However, the synthesis pathway of the PUFA-containing NATs remains undiscovered. Here, we report that human livers synthesize NATs and that the acyl-chain preference is similar in murine liver homogenates. In the mouse, we found that hepatic NAT synthase activity localizes to the peroxisome and depends upon an active-site cysteine. Using unbiased metabolomics and proteomics, we identified bile acid-CoA:amino acid N-acyltransferase (BAAT) as the likely hepatic NAT synthase in vitro. Subsequently, we confirmed that BAAT knockout livers lack up to 90% of NAT synthase activity and that biliary PUFA-containing NATs are significantly reduced compared to wildtype. In conclusion, we identified the in vivo PUFA-NAT synthase in the murine liver and expanded the known substrates of the bile acid-conjugating enzyme, BAAT, beyond classic bile acids to the synthesis of a novel class of bioactive lipids.
Source
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J Lipid Res
. 2023 Mar 21;100361. doi: 10.1016/j.jlr.2023.100361. Online ahead of print.
Language
A language of the resource
English
2023
Bile Acids and Salts/biosynthesis
Bile Acids and Salts/metabolism
fatty acid amide hydrolase
Liver
Metabolomics
N-acyl amino acid
N-acyl taurine
Omega-3 fatty acids
peroxisomes
proteomics
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1097/MJT.0000000000001619
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Title
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A Comparison of Variable Versus Fixed Insulin Infusion Rate on Resolution of Diabetic Ketoacidosis
Creator
An entity primarily responsible for making the resource
Nathan Bohach
John M Moorman
Brittany Cunningham
Chanda Mullen
Melissa Fowler
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Diabetic ketoacidosis (DKA) is a well-known, potentially fatal complication of diabetes. The American Diabetes Association hyperglycemic crises guidelines suggest the use of intravenous insulin in patients presenting with DKA, along with a recommended rate of glucose reduction of 50-75 mg/dL/h. However, no specific guidance is provided regarding how to best achieve this rate of glucose decline.
Study question: Is there a difference in time to DKA resolution between a variable intravenous insulin infusion strategy and a fixed infusion strategy in the absence of an institutional protocol?
Study design: Single-center, retrospective cohort study of DKA patient encounters in 2018.
Measures and outcomes: Insulin infusion strategy was considered to be variable if the infusion rate changed within the first 8 hours of therapy or was considered fixed if the rate remained unchanged for the same period. The primary outcome was time to resolution of DKA. Secondary outcomes were hospital length of stay, intensive care unit length of stay, hypoglycemia, mortality, and DKA recurrence.
Results: The median time to resolution of DKA was 9.3 hours in the variable infusion group compared with 7.8 hours in the fixed infusion group (HR, 0.82; 95% CI, 0.43-1.5, P = 0.5360). Severe hypoglycemia was observed in 13% of patients in the variable infusion group and in 50% of patients in the fixed infusion group (P = 0.006).
Conclusions: In this analysis, insulin infusion strategy (variable vs. fixed) was not associated with a significant difference in the time to resolution of DKA in the absence of an institutional protocol. The fixed infusion strategy was associated with a higher incidence of severe hypoglycemia.
Source
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Am J Ther
. 2023 Mar 3. doi: 10.1097/MJT.0000000000001619. Online ahead of print.
Language
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English
2023
-
Hyperlink
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URL
10.1093/ajhp/zxad043
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Title
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Concurrent validity of the Professional Fulfillment Index in a sample of pharmacy residents and preceptors
Creator
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Kyle A Gustafson
Brittany Bates
Kristine M Cline
M David Gothard
Publisher
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Am J Health Syst Pharm
. 2023 Mar 1;zxad043. doi: 10.1093/ajhp/zxad043. Online ahead of print.
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose: The purpose of this study was to validate the Stanford Professional Fulfillment Index (PFI) for assessment of burnout and professional fulfillment in a study population of pharmacy residents and residency preceptors.
Summary: The historical gold standard for assessing professional burnout is the Maslach Burnout Inventory (MBI); there is no established standard for professional fulfillment. The PFI is a 16-question assessment that has previously been validated in medical residents and practicing physicians. In this study, surveys including both PFI and MBI items were sent to active pharmacy residents and residency preceptors. To determine concurrent validity, domains of the PFI were compared to the closest related MBI domain as well as composite burnout rates measured in each portion of the survey. A total of 142 preceptors and 68 residents completed both the PFI and a version of the MBI previously validated in physicians. In assessing indicators of pharmacist burnout and fulfillment, data captured by domains of the PFI closely correlated with data captured by corresponding domains of the MBI (Pearson correlations of 0.683-0.822), with high internal consistency (Cronbach α of 0.866-0.903).
Conclusion: The PFI is a valid method of assessing burnout in both pharmacy residents and residency preceptors. Additionally, the PFI contributes a reliable system of assessing professional fulfillment while also being highly accessible for both research and residency program monitoring applications.
Source
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Am J Health Syst Pharm
. 2023 Mar 1;zxad043. doi: 10.1093/ajhp/zxad043. Online ahead of print.
Language
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English
-
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URL
10.1016/j.jemermed.2022.12.021
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Title
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Spontaneous Hyphema and Vitreous Hemorrhage Causing Secondary Glaucoma in a Patient on Apixaban
Creator
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Robert T Stenberg
Jacob Nelson
Jeffrey Rabinowitz
Erin L Simon
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Spontaneous hyphema is the rare occurrence of hemorrhage within the anterior chamber of the eye without a predisposing traumatic event. Hyphema can be associated with acute elevations in intraocular pressure in up to 30% of cases, which poses a significant risk for permanent vision loss if not quickly recognized and treated in the emergency department (ED). Anticoagulant and antiplatelet medications have been previously associated with cases of spontaneous hyphema; however, there are limited reports of hyphema with associated acute glaucoma in a patient taking a direct oral anticoagulant. Due to the limited data of reversal therapies for direct oral anticoagulants in intraocular hemorrhage, these patients pose a challenge in deciding whether to reverse anticoagulation in the ED.
Case report: We present a case of a 79-year-old man on apixaban anticoagulation therapy who presented to the ED with spontaneous painful vision loss in the right eye with associated hyphema. Point-of-care ultrasound revealed an associated vitreous hemorrhage, and tonometry was significant for acute glaucoma. As a result, the decision was made to reverse the patient's anticoagulation with four-factor activated prothrombin complex concentrate. Why Should an Emergency Physician Be Aware of This? This case is an example of acute secondary glaucoma due to a hyphema and vitreous hemorrhage. There is limited evidence regarding anticoagulation reversal in this setting. A second site of bleeding was identified by utilization of point-of-care ultrasound, which led to the diagnosis of a vitreous hemorrhage. This allowed for shared decision-making between the emergency physician, ophthalmologist, and patient regarding the risks and potential benefits of the reversal of anticoagulation. Ultimately, the patient decided to have his anticoagulation reversed to try and preserve vision.
Source
A related resource from which the described resource is derived
J Emerg Med
. 2023 Feb 28;S0736-4679(22)00801-0. doi: 10.1016/j.jemermed.2022.12.021. Online ahead of print.
Language
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English
-
Hyperlink
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URL
10.1016/j.jtcvs.2023.01.032
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Title
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Lung cancer screening utilization rate varies based on patient, provider, and hospital factors
Creator
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Tarik Whitham
Koffi Wima
Brett Harnett
John R Kues
Mark H Eckman
Sandra L Starnes
Katherine A Schmidt
Sangita Kapur
Hai Salfity
Robert M Van Haren
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
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Objective: Low-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening.
Methods: We performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened.
Results: A total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05).
Conclusions: Lung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.
Source
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J Thorac Cardiovasc Surg
. 2023 Feb 21;S0022-5223(23)00172-1. doi: 10.1016/j.jtcvs.2023.01.032. Online ahead of print.
Language
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English
-
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URL
10.1093/schbul/sbac208
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Diminished Auditory Cortex Dynamic Range and its Clinical Correlates in First Episode Psychosis
Creator
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Alfredo L Sklar
Xi Ren
Lydia Chlpka
Mark Curtis
Brian A Coffman
Dean F Salisbury
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background and hypothesis: There is growing appreciation for the contribution of sensory disruptions to disease morbidity in psychosis. The present study examined auditory cortex (AC) dynamic range: the scaling of neurophysiological responses to stimulus intensity, among individuals with a schizophrenia spectrum illness (FESz) and its relationship to clinical outcomes at disease onset.
Study design: Magnetoencephalography (MEG) was recorded from 35 FESz and 40 healthy controls (HC) during binaural presentation of tones at three intensities (75 dB, 80 dB, and 85 dB). MRIs were obtained to enhance cortical localization of MEG sensor-level activity. All participants completed the MATRICS cognitive battery (MCCB) and Global Functioning: Role and Social scales (GFR/GFS). Patients were administered the Positive and Negative Syndrome Scale (PANSS).
Study results: FESz exhibited reduced AC response relative to HC. Enhancement of AC activity to tones of increasing intensity was blunted in FESz relative to HC. Reduced dynamic range (85-75 dB AC response) was associated with lower GFS (r = .58) and GFR (r = .45) scores, worse MCCB performance (r = .45), and increased PANSS Negative symptom subscale scores (r = -.55) among FESz, relationships not observed with AC responses to individual tones.
Conclusion: Beyond an impaired AC response to pure tones, FESz exhibit reduced dynamic range relative to HC. This impairment was correlated with markers of disease morbidity including poorer community functioning as well as cognitive and negative symptoms. The relationship with impaired social functioning may reflect the role of AC dynamic range in decoding the emotional content of language and highlights its importance to future therapeutic sensory remediation protocols.
Source
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Schizophr Bull
. 2023 Feb 7;sbac208. doi: 10.1093/schbul/sbac208. Online ahead of print.
Language
A language of the resource
English
2023
auditory processing
First episode psychosis
magnetoencephalography
psychometric function
social functioning
sound intensity
-
Hyperlink
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URL
10.1038/s41390-023-02564-8
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Title
A name given to the resource
Epidemiology data on the cost and outcomes associated with pediatric acute kidney injury
Creator
An entity primarily responsible for making the resource
Rupesh Raina
Sidharth Sethi
Varun Aitharaju
Ananya Vadhera
Imad Haq
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Hospitalized children with acute kidney injury (AKI) have not been extensively studied for clinical outcomes including hospital stay, the need for mechanical ventilation, mortality rates, and healthcare utilization. We hypothesize significant financial costs and increased morbidity and mortality associated with pediatric AKI.
Methods: This is a retrospective study of pediatric patients (age ≤18 years) included in the Kids' Inpatient Database (KID) between January 1, 2016, and December 31, 2021. The results of the data analysis were utilized for comparative testing between the AKI and non-AKI cohorts.
Results: The study included 4842 children [with AKI (n = 2424) and without AKI (n = 2418)]. The odds of mortality (p = 0.004) and mechanical ventilation (p < 0.001) were observed to be significantly higher among those with AKI as compared to those without AKI. Additionally, the median (IQR) duration of stay in the hospital (p < 0.001) and total cost (p < 0.001) were significantly higher among those with AKI vs. those without AKI.
Conclusions: AKI in children was associated with higher odds of mortality, longer duration of hospital stay, increased requirement of mechanical ventilation, and increased hospital expenditure. The scientific community can utilize this information to better understand the outcomes associated with this disease process in this patient population.
Impact: This article has thoroughly evaluated epidemiologic data associated with pediatric acute kidney injury (AKI) in hospitalized patients This study assesses mortality, hospital expenditure, and other factors to strengthen single-center and few multi-center studies and provides novel data regarding insurance and cost associated with pediatric AKI With increased knowledge of current epidemiology and risk factors, the scientific community can better understand prevention and outcomes in hospitalized children with AKI.
Source
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Pediatr Res
. 2023 Mar 22. doi: 10.1038/s41390-023-02564-8. Online ahead of print.
Language
A language of the resource
English
2023
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1016/j.ajem.2023.02.021
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Patients utilizing emergency medical services - Does facility type matter?
Creator
An entity primarily responsible for making the resource
Erin L Simon
Bhanu Wahi-Singh
Baruch S Fertel
Luke Weber
Jessica Krizo
Caroline Mangira
Courtney M Smalley
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Emergency departments (EDs) play a critical role in the US healthcare system. As freestanding EDs (FSEDs) are integrated into the acute care landscape, local EMS providers are transporting to these facilities, which may be closer in proximity and provide faster turnaround times. We hypothesized that patients transported via EMS to a freestanding ED required fewer tests and are admitted less frequently than those transported to a HBED. Our objective was to compare testing frequency and admission rates between patients transported via EMS to a FSED vs. HBED.
Methods: This was a retrospective cohort study of all patients who presented within a large integrated hospital system via EMS to one of 10 HBEDs or one of 6 FSEDs between April 1, 2020 - May 1, 2021. Categorical variables are presented as frequencies and percentages and comparisons between groups were obtained using chi squared tests. Continuous variables are presented as mean and standard deviation and p-values comparing groups were obtained using t-tests. Multiple logistic regression was used to assess the effect of ED type on admission status, labs ordered, and testing performed.
Results: A total of 123,120 encounters were included in our study. Mean age at the FSEDs was 59.9 vs. 61.3 at the HBEDs. At the FSEDs 55.6% (n = 4675) were female vs. 53.0% (n = 60,809) at the HBEDs. At the FSEDs 82.0% (n = 6805) were White vs. 60.7% (n = 68,430) at the HBEDs. We found 50.0% (n = 3974) had Medicare at the FSEDs vs 50.9% (n = 55,372) at the FSEDs. At the FSEDs, 69.5% (n = 5846) had bloodwork vs. 82.4% (n = 94,512) at the HBEDs; 68.3% (n = 5745) had an x-ray at the FSEDs vs. 70.7% (n = 81,089) at the HBEDs; 40.1% (n = 3370) had a CT scan at the FSEDs vs. 44.9% (n = 51,503) at the HBEDs; and 40.6% (n = 3412) were admitted at the FSEDs vs. 56.1% (n = 64,355) at the HBEDs. After controlling for Charlson Comorbidity Index, acuity, age, gender, sex, insurance and race, patients in FSEDs were 35% less likely to be admitted as compared to HBEDs.
Conclusion: Patients brought in via EMS to a FSED were less likely to have blood work, x-ray, or CT scan, and were less likely to be admitted to the hospital than those transported to a HBED.
Source
A related resource from which the described resource is derived
Am J Emerg Med
. 2023 Feb 21;68:38-41. doi: 10.1016/j.ajem.2023.02.021. Online ahead of print.
Language
A language of the resource
English
2023
Admission rate
Emergency Medical Services
Freestanding emergency department
testing frequency
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1177/00099228221150115
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Title
A name given to the resource
Fulfilling 6 Domains of Health Care Quality: A Qualitative Parental Caregiver Study of Pediatric Telehealth During a Pandemic
Creator
An entity primarily responsible for making the resource
Julie Aultman
Mandip Bassi
Gwendolyn Richner
Sarah Delahanty
Sarah Rush
Steven Spalding
Daniel Grossoehme
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Using qualitative methods, we examine telehealth care quality from the perspective of parents of pediatric patients during a pandemic. We fill a gap in the literature essential for measuring effectiveness of pediatric telehealth. A total of 22 participants (n = 21 female; n = 1 male) enrolled in 1 of 9 interviews and focus groups conducted in 2021. Transcribed data were thematically analyzed and organized based on the 6 domains of quality health care by the Institute of Medicine (IOM). Analyzed data revealed 7 themes and 52 codes. Pediatric telehealth visits were perceived as efficient, timely, safe, and generally effective by parents for their child's health care. Participants experienced equal or greater time with their child's care provider via telehealth than through in-person visits. Qualitative results directly align with IOM domains of quality health care and contribute to the growing literature and evidence that may lead to improved telehealth outcomes and better preparedness for emergent public health events.
Source
A related resource from which the described resource is derived
Clin Pediatr (Phila)
. 2023 Jan 23;99228221150115. doi: 10.1177/00099228221150115. Online ahead of print.
Language
A language of the resource
English
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1016/j.jss.2022.12.025
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Title
A name given to the resource
Trends in Integrated Plastic Surgery Applicant, Resident, and Junior Attending Research Productivity
Creator
An entity primarily responsible for making the resource
Sanjay K A Jinka
Benjamin A Sarac
Austin P Seaman
Samantha L Fry
Maria T Huayllani
Jeffrey E Janis
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Introduction: Research productivity is critical for matching into integrated plastic surgery residency. This study will identify how pre and intraresidency research productivity correlate with resident/junior attending productivity.
Materials and methods: Retrospective review from 2006 to 2015 issues of the American Board of Plastic Surgery's Annual Newsletter to Diplomates was performed to identify newly board certified plastic surgeons. Only surgeons from US medical schools matching directly into integrated programs were included. Residency type/length, graduation year from medical school, and publication counts were recorded for each surgeon. Publications were categorized as preresidency, intraresidency, and junior attending (6 y post residency/fellowship training).
Results: Six hundred fifty-five integrated plastic surgery graduates were analyzed. The median number of total publications (preresidency, intraresidency, and junior attending) was 4 (interquartile range [IQR], 1 to 10). Linear regression revealed negligible correlation between preresidency and junior attending publications (r = 0.019, P = 0.002). Total publications and increasing graduation y had a significant correlation of 0.89 (P < 0.001). Graduates of fellowships had significantly increased median total publications compared to those without fellowships (7 IQR, 3 to 18 versus 3 IQR, 1 to 7, respectively, P < 0.001). Dedicated research years during residency were associated with significant (P < 0.001) increases in median total and junior attending publications. Total publications ranged from 3 (IQR, 1 to 6) to 8 (IQR, 7 to 18) for those who completed 5- and 8-y residencies, respectively.
Conclusions: Increased preresidency research productivity is not strongly associated with increased junior attending productivity in integrated plastic surgery. Better markers are completing dedicated research years in residency or fellowship after residency.
Source
A related resource from which the described resource is derived
10.1016/j.jss.2022.12.025
Language
A language of the resource
English
2023
fellowship
Integrated plastic surgery
Medical school
Publications
Research productivity
residency
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1111/jgs.18329
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
"At least we finally found out what it was": Dementia diagnosis in minoritized populations
Creator
An entity primarily responsible for making the resource
Marcela D Blinka
Sneha Gundavarpu
Dorcas Baker
Roland J Thorpe Jr
Joseph J Gallo
Quincy M Samus
Halima Amjad
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Disparities in diagnosis persist among persons living with dementia (PLWD); most research on delayed diagnosis relies on medical records or administrative claims. This study aimed to identify factors that delay or facilitate dementia diagnoses in racial or ethnic minoritized PLWD and elicit care partner perspectives on timing and effects of diagnosis.
Methods: Maryland-based participants cared for a PLWD age 60 or older, self-identified as Black/African/African-American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in-depth, semi-structured interviews were conducted and analyzed using conventional qualitative content analysis methods.
Results: Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding dementia influenced recognition and discussion of dementia among families and communities. Diagnoses were family-initiated and started in primary care. Care partners were divided in their perceptions of diagnosis timeliness and whether earlier diagnosis would have changed outcomes. Family reactions to dementia diagnoses varied; most participants expressed a strong sentiment of service and duty to care for older family members. Participants overwhelmingly felt the benefits of obtaining a dementia diagnosis outweighed harms.
Conclusions: Numerous factors affect dementia diagnosis in racial and ethnic minoritized PLWD. Normalization of brain health discussions and systematic, proactive discussion and detection of dementia in primary care may address multilevel barriers and facilitators to diagnosis. Systems-level and community-led public health interventions may also help address disparities in brain health education and dementia diagnosis.
Source
A related resource from which the described resource is derived
J Am Geriatr Soc
. 2023 Mar 13. doi: 10.1111/jgs.18329. Online ahead of print.
Language
A language of the resource
English
2023
caregiver perspectives
dementia diagnosis
minoritized populations
qualitative study
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.2337/dc22-0622
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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The National Clinical Care Commission Report to Congress: Summary and Next Steps
Creator
An entity primarily responsible for making the resource
Paul R Conlin
John M Boltri
Ann Bullock
M Carol Greenlee
Aaron M Lopata
Clydette Powell
Dean Schillinger
Howard Tracer
William H Herman
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
The U.S. is experiencing an epidemic of type 2 diabetes. Socioeconomically disadvantaged and certain racial and ethnic groups experience a disproportionate burden from diabetes and are subject to disparities in treatment and outcomes. The National Clinical Care Commission (NCCC) was charged with making recommendations to leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC determined that diabetes cannot be addressed simply as a medical problem but must also be addressed as a societal problem requiring social, clinical, and public health policy solutions. As a result, the NCCC's recommendations address policies and programs of both non-health-related and health-related federal agencies. The NCCC report, submitted to the U.S. Congress on 6 January 2022, makes 39 specific recommendations, including three foundational recommendations that non-health-related and health-related federal agencies coordinate their activities to better address diabetes, that all federal agencies and departments ensure that health equity is a guiding principle for their policies and programs that impact diabetes, and that all Americans have access to comprehensive and affordable health care. Specific recommendations are also made to improve general population-wide policies and programs that impact diabetes risk and control, to increase awareness and prevention efforts among those at high risk for type 2 diabetes, and to remove barriers to access to effective treatments for diabetes and its complications. Finally, the NCCC recommends that an Office of National Diabetes Policy be established to coordinate the activities of health-related and non-health-related federal agencies to address diabetes prevention and treatment. The NCCC urges Congress and the Secretary of Health and Human Services to implement these recommendations to protect the health and well-being of the more than 130 million Americans at risk for and living with diabetes.
Source
A related resource from which the described resource is derived
Diabetes Care
. 2023 Feb 1;46(2):e60-e63. doi: 10.2337/dc22-0622.
Language
A language of the resource
English
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1097/ACM.0000000000004963
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Competencies for the Use of Artificial Intelligence-Based Tools by Health Care Professionals
Creator
An entity primarily responsible for making the resource
Regina G Russell
Laurie Lovett Novak
Mehool Patel
Kim V Garvey
Kelly Jean Thomas Craig
Gretchen P Jackson
Don Moore
Bonnie M Miller
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Purpose: The expanded use of clinical tools that incorporate artificial intelligence (AI) methods has generated calls for specific competencies for effective and ethical use. This qualitative study used expert interviews to define AI-related clinical competencies for health care professionals.
Method: In 2021, a multidisciplinary team interviewed 15 experts in the use of AI-based tools in health care settings about the clinical competencies health care professionals need to work effectively with such tools. Transcripts of the semistructured interviews were coded and thematically analyzed. Draft competency statements were developed and provided to the experts for feedback. The competencies were finalized using a consensus process across the research team.
Results: Six competency domain statements and 25 subcompetencies were formulated from the thematic analysis. The competency domain statements are: (1) basic knowledge of AI: explain what AI is and describe its health care applications; (2) social and ethical implications of AI: explain how social, economic, and political systems influence AI-based tools and how these relationships impact justice, equity, and ethics; (3) AI-enhanced clinical encounters: carry out AI-enhanced clinical encounters that integrate diverse sources of information in creating patient-centered care plans; (4) evidence-based evaluation of AI-based tools: evaluate the quality, accuracy, safety, contextual appropriateness, and biases of AI-based tools and their underlying data sets in providing care to patients and populations; (5) workflow analysis for AI-based tools: analyze and adapt to changes in teams, roles, responsibilities, and workflows resulting from implementation of AI-based tools; and (6) practice-based learning and improvement regarding AI-based tools: participate in continuing professional development and practice-based improvement activities related to use of AI tools in health care.
Conclusions: The 6 clinical competencies identified can be used to guide future teaching and learning programs to maximize the potential benefits of AI-based tools and diminish potential harms.
Source
A related resource from which the described resource is derived
Acad Med
. 2023 Mar 1;98(3):348-356. doi: 10.1097/ACM.0000000000004963. Epub 2022 Sep 6.
Language
A language of the resource
English
2023
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1016/j.jdin.2023.01.023
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Teledermatology in medical student, postgraduate trainee, and global dermatology education: A systematic review
Creator
An entity primarily responsible for making the resource
Heli Patel
Rishab Revankar
Aly Valliani
Nikita Revankar
Shivani Yerigeri
Nadine Kaskas
Benjamin Stoff
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: In the aftermath of the COVID-19 pandemic, medical students and residents in the U.S. and globally have gained more exposure to teledermatology, both for the purposes of clinical practice and education.
Objective: We conducted a systematic review to assess outcomes from teledermatology interventions for dermatology trainees in the U.S. and globally in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA).
Methods: We searched MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL for articles written in English and published database inception to November 20, 2022.
Results: In total, 15 studies met the inclusion criteria. Outcomes reported ranged broadly from resident-provider concordance rates, diagnostic accuracy in comparison to control groups, number of patients seen, and self-reported satisfaction and improvement. Generally, studies indicated high satisfaction rates and improvement in educational outcomes among medical students, residents, and other trainees in the global health setting.
Limitations: Because of the heterogeneity of study design and outcomes reported, meta-analysis could not be performed.
Conclusion: Teledermatology can be successfully deployed for clinical care and education domestically and in the global health setting.
Source
A related resource from which the described resource is derived
JAAD Int
. 2023 Jun;11:106-111. doi: 10.1016/j.jdin.2023.01.023. Epub 2023 Feb 19.
Language
A language of the resource
English
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.3390/cells12020242
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Roles of Bone Marrow-Derived Stem Cells in Coronary Collateral Growth Induced by Repetitive Ischemia
Creator
An entity primarily responsible for making the resource
Molly Enrick
Anurag Jamaiyar
Vahagn Ohanyan
Cody Juguilon
Christopher Kolz
Xin Shi
Danielle Janota
Weiguo Wan
Devan Richardson
Kelly Stevanov
Tatevik Hakobyan
Lindsay Shockling
Arianna Diaz
Sharon Usip
Feng Dong
Ping Zhang
William M Chilian
Liya Yin
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Many clinical trials have attempted to use stem cells to treat ischemic heart diseases (IHD), but the benefits have been modest. Though coronary collaterals can be a "natural bypass" for IHD patients, the regulation of coronary collateral growth (CCG) and the role of endogenous stem cells in CCG are not fully understood. In this study, we used a bone marrow transplantation scheme to study the role of bone marrow stem cells (BMSCs) in a rat model of CCG. Transgenic GFP rats were used to trace BMSCs after transplantation; GFP bone marrow was harvested or sorted for bone marrow transplantation. After recovering from transplantation, the recipient rats underwent 10 days of repetitive ischemia (RI), with echocardiography before and after RI, to measure cardiac function and myocardial blood flow. At the end of RI, the rats were sacrificed for the collection of bone marrow for flow cytometry or heart tissue for imaging analysis. Our study shows that upon RI stimulation, BMSCs homed to the recipient rat hearts' collateral-dependent zone (CZ), proliferated, differentiated into endothelial cells, and engrafted in the vascular wall for collateral growth. These RI-induced collaterals improved coronary blood flow and cardiac function in the recipients' hearts during ischemia. Depletion of donor CD34+ BMSCs led to impaired CCG in the recipient rats, indicating that this cell population is essential to the process. Overall, these results show that BMSCs contribute to CCG and suggest that regulation of the function of BMSCs to promote CCG might be a potential therapeutic approach for IHD.
Source
A related resource from which the described resource is derived
Cells
. 2023 Jan 6;12(2):242. doi: 10.3390/cells12020242.
Language
A language of the resource
English
2023
bone marrow stem cells
Coronary blood flow
coronary collateral growth
Coronary microcirculation
repetitive ischemia
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1093/jac/dkad060
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Gepotidacin: a novel, oral, 'first-in-class' triazaacenaphthylene antibiotic for the treatment of uncomplicated urinary tract infections and urogenital gonorrhoea
Creator
An entity primarily responsible for making the resource
Richard R Watkins
Dipendra Thapaliya
Tracy L Lemonovich
Robert A Bonomo
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
The ongoing spread of antimicrobial resistance has made the treatment of uncomplicated urinary tract infections (UTIs) and urogenital gonorrhoea increasingly difficult. New oral treatment options are urgently needed. Gepotidacin (previously GSK2140944) is a novel, bactericidal, oral, 'first-in-class' triazaacenaphthylene antibiotic that inhibits bacterial DNA replication by blocking two essential topoisomerase enzymes. Mutations in both enzymes would likely be necessary for resistance to occur, thus raising hopes that the drug will be able to maintain long-term effectiveness. Data from Phase II clinical trials of gepotidacin in UTIs and urogenital gonorrhoea appear promising, and Phase III trials are underway. In this review we summarize the development of gepotidacin and discuss its potential role in clinical practice. If approved, gepotidacin will be the first new oral antibiotic for UTIs in more than 20 years.
Source
A related resource from which the described resource is derived
J Antimicrob Chemother
. 2023 Mar 8;dkad060. doi: 10.1093/jac/dkad060. Online ahead of print.
Language
A language of the resource
English
2023
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1017/S1478951523000287
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Children's understanding of dying and death: A multinational grounded theory study
Creator
An entity primarily responsible for making the resource
Paula McPoland
Daniel H Grossoehme
Denice C Sheehan
Pamela Stephenson
Julia Downing
Theony Deshommes
Pascale Y H Gassant
Sarah Friebert
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Objectives: The ways in which children understand dying and death remain poorly understood; most studies have been carried out with samples other than persons with an illness. The objective of this study was to understand the process by which children directly involved with life-limiting conditions understand dying and death.
Methods: This qualitative study obtained interview data from N = 44 5-18-year-old children in the USA, Haiti, and Uganda who were pediatric palliative care patients or siblings of patients. Of these, 32 were children with a serious condition and 12 were siblings of a child with a serious condition. Interviews were recorded, transcribed, verified, and analyzed using grounded theory methodology.
Results: Loss of normalcy and of relationships emerged as central themes described by both ill children and siblings. Resilience, altruism, and spirituality had a bidirectional relationship with loss, being strategies to manage both losses and anticipated death, but also being affected by losses. Resiliency and spirituality, but not altruism, had a bidirectional relationship with anticipating death. Themes were consistent across the 3 samples, although the beliefs and behaviors expressing them varied by country.
Significance of results: This study partially fills an identified gap in research knowledge about ways in which children in 3 nations understand dying and death. While children often lack an adult vocabulary to express thoughts about dying and death, results show that they are thinking about these topics. A proactive approach to address issues is warranted, and the data identify themes of concern to children.
Source
A related resource from which the described resource is derived
Palliat Support Care
. 2023 Mar 24;1-8. doi: 10.1017/S1478951523000287. Online ahead of print.
Language
A language of the resource
English
2023
Children
Cross-cultural
Death
Grounded theory
Qualitative
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://pubmed.ncbi.nlm.nih.gov/36852309/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Primary care Providers' approaches to cervical cancer screening in Muslim females
Creator
An entity primarily responsible for making the resource
Sondos Al Sad
Radhika Pandit
Nooralhuda Alhashim
Mahmoud Abdel-Rasoul
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
The utilization of the Papanicolaou (Pap) test and the human papillomavirus (HPV) vaccine has significantly decreased rates of cervical cancer and related mortality. Disparities in receiving these preventive screenings are scarcely studied in Muslim females. Our study explores primary care providers' (PCP) approaches to cervical cancer screening in Muslim females. We created a cross-sectional Qualtrics survey using convenience sampling of PCPs who perform Pap tests in central Ohio. Recruitment emails were disseminated via departmental email listservs. We had 200 analyzable responses and 78% of respondents reported having Muslim patients. Bivariate analysis was used to identify predictors of providers' approaches. Providers younger than 35 years obtained a sexual history from Muslim females less frequently, family medicine providers were more likely to obtain a sexual history from Muslim females, and gynecologists were more likely to offer the HPV vaccine to Muslim females. Providers who counseled patients about Pap tests (P<0.001) and HPV modes of transmission (P<0.004) were more likely to offer cervical cancer screening for Muslim females. Our findings suggested that providers' age and specialty may be predictors of proactive cervical cancer screening and prevention in Muslim females and that there is a gap between current guidelines and preventive clinical practices regarding the HPV vaccine and transmission counseling.
Source
A related resource from which the described resource is derived
Prev Med Rep
. 2023 Feb 4;32:102126. doi: 10.1016/j.pmedr.2023.102126. eCollection 2023 Apr.
Language
A language of the resource
English
2023
Health equity
Muslim patients
Preventive screening
Public Health
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1097/DAD.0000000000002355
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Malignant Melanoma Arising in a Prolific Nevus Sebaceus With Colonization of Trichoblastoma
Creator
An entity primarily responsible for making the resource
Kelly M Kimball
Elise Craig
Carl Barrick
Arif Usmani
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Nevus sebaceus (NS) is a cutaneous hamartoma typically found on the head and neck, with a prevalence of 0.3% in newborns. Most NS are quiescent; however, benign and malignant lesions have been reported to arise within these nevi. Malignant transformation is not common but mainly includes basal cell carcinoma and squamous cell carcinoma. Malignant melanoma arising in NS is exceedingly rare, with only 2 previously documented cases. In this article, we report the first case of malignant melanoma arising in a NS in a 68-year-old man in the United States.
Source
A related resource from which the described resource is derived
Am J Dermatopathol
. 2023 Mar 1;45(3):196-200.
Language
A language of the resource
English
2023
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1038/s42003-022-04397-3
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Insights into pyrrolysine function from structures of a trimethylamine methyltransferase and its corrinoid protein complex
Creator
An entity primarily responsible for making the resource
Jiaxin Li
Patrick T Kang
Ruisheng Jiang
Jodie Y Lee
Jitesh A Soares
Joseph A Krzycki
Michael K Chan
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Source
A related resource from which the described resource is derived
Commun Biol
. 2023 Jan 16;6(1):54. doi: 10.1038/s42003-022-04397-3.
Language
A language of the resource
English
2023
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1016/j.resuscitation.2023.109735
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Title
A name given to the resource
Preclinical evaluation of triiodothyronine nanoparticles as a novel therapeutic intervention for resuscitation from cardiac arrest
Creator
An entity primarily responsible for making the resource
Brian R Weil
Shannon E Allen
Thomas Barbaccia
Kimberly Wong
Abigail M Beaver
Elizabeth A Slabinski
Jeffrey G Mellott
Peter C Taylor Dickinson
Shaker A Mousa
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Given emerging evidence of rapid non-genomic cytoprotective effects of triiodothyronine (T3), we evaluated the resuscitative efficacy of two nanoparticle formulations of T3 (T3np) designed to prolong cell membrane receptor-mediated signaling.
Methods: Swine (n = 40) were randomized to intravenous vehicle (empty np), EPI (0.015 mg/kg), T3np (0.125 mg/kg), or T3np loaded with phosphocreatine (T3np + PCr; 0.125 mg/kg) during CPR following 7-min cardiac arrest (n = 10/group). Hemodynamics and biomarkers of heart (cardiac troponin I; cTnI) and brain (neuron-specific enolase; NSE) injury were assessed for up to 4-hours post-ROSC, at which time the heart and brain were collected for post-mortem analysis.
Results: Compared with vehicle (4/10), the rate of ROSC was higher in swine receiving T3np (10/10; p < 0.01), T3np + PCr (8/10; p = 0.08) or EPI (10/10; p < 0.01) during CPR. Although time to ROSC and survival duration were comparable between groups, EPI was associated with a ∼2-fold higher post-ROSC concentration of cTnI vs T3np and T3np + PCr and the early post-ROSC rise in NSE and neuronal injury were attenuated in T3np-treated vs EPI-treated animals. Analysis of hippocampal ultrastructure revealed deterioration of mitochondrial integrity, reduced active zone length, and increased axonal vacuolization in EPI-treated animals vs controls. However, the frequency of these abnormalities was diminished in animals resuscitated with T3np.
Conclusions: T3np achieved a ROSC rate and post-ROSC survival that was superior to vehicle and comparable to EPI. The attenuation of selected biomarkers of cardiac and neurologic injury at individual early post-ROSC timepoints in T3np-treated vs EPI-treated animals suggests that T3np administration during CPR may lead to more favorable outcomes in cardiac arrest.
Source
A related resource from which the described resource is derived
Resuscitation
. 2023 Feb 16;109735. doi: 10.1016/j.resuscitation.2023.109735. Online ahead of print.
Language
A language of the resource
English
2023
cardiac arrest
Ischemic Injury
Nanoparticles
Phosphocreatine
Thyroid hormone
triiodothyronine
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.3233/PRM-220048
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Title
A name given to the resource
Efficacy of intrathecal morphine administration in pediatric patients undergoing selective dorsal rhizotomy
Creator
An entity primarily responsible for making the resource
Jared Pennington
Shawnelle Contini
Miraides Brown
Nupur Goel
Tsulee Chen
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Purpose: The purpose of this study was to evaluate the effectiveness of intrathecal morphine following selective dorsal rhizotomy in pediatric patients previously diagnosed with cerebral palsy.
Methods: This was a retrospective, cohort analysis over the course of four years. The analysis consisted of a treatment group which received intrathecal morphine (5 mcg/kg) injection and a control group that did not receive the injection prior to dural closure. All patients underwent multilevel laminectomies for selective dorsal rhizotomy at Akron Children's Hospital. The effectiveness of the treatment was measured by total dose of hydromorphone administered on patient-controlled analgesia (PCA), number of days on oral narcotics, and cumulative dose of oral narcotic.
Results: Of the analyzed 15 pediatric patients, seven patients received intrathecal morphine injection while the other eight did not receive the treatment prior to dural closure. There was a difference of 1135 mcg in total PCA dose between the study group (3243 mcg) and the control group (4378 mcg). The total PCA dose based on weight was lower in the study group (163 mcg/kg) than in the control group (171 mcg/kg).
Conclusion: Based on these findings, the administration of intrathecal morphine clinically reduces the opiate need in the first 96 hours post-operatively.
Source
A related resource from which the described resource is derived
J Pediatr Rehabil Med
. 2023 Feb 16. doi: 10.3233/PRM-220048. Online ahead of print.
Language
A language of the resource
English
2023
Cerebral palsy
intrathecal morphine
pain control
Selective dorsal rhizotomy
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1111/petr.14490
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Title
A name given to the resource
The effects of COVID-19 on pediatric and adult solid organ transplant recipients and the emergence of telehealth
Creator
An entity primarily responsible for making the resource
Rupesh Raina
Raghav Shah
Stephen D Marks
Jonathan N Johnson
Matthew Nied
Girish C Bhatt
Clark A Bonham
Nithin Datla
Sidharth Kumar Sethi
Sharon M Bartosh
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: The SARS-CoV-2 pandemic and corresponding acute respiratory syndrome have affected all populations and led to millions of deaths worldwide. The pandemic disproportionately affected immunocompromised and immunosuppressed adult patients who had received solid organ transplants (SOTs). With the onset of the pandemic, transplant societies across the world recommended reducing SOT activities to avoid exposing immunosuppressed recipients. Due to the risk of COVID-19-related outcomes, SOT providers adapted the way they deliver care to their patients, leading to a reliance on telehealth. Telehealth has helped organ transplant programs continue treatment regimens while protecting patients and physicians from COVID-19 transmission. This review highlights the adverse effects of COVID-19 on transplant activities and summarizes the increased role of telehealth in the management of solid organ transplant recipients (SOTRs) in both pediatric and adult populations.
Methods: A comprehensive systematic review and meta-analysis were conducted to accentuate the outcomes of COVID-19 and analyze the efficacy of telehealth on transplant activities. This in-depth examination summarizes extensive data on the clinical detriments of COVID-19 in transplant recipients, advantages, disadvantages, patient/physician perspectives, and effectiveness in transplant treatment plans via telehealth.
Results: COVID-19 has caused an increase in mortality, morbidity, hospitalization, and ICU admission in SOTRs. Telehealth efficacy and benefits to both patients and physicians have increasingly been reported.
Conclusions: Developing effective systems of telehealth delivery has become a top priority for healthcare providers during the COVID-19 pandemic. Further research is necessary to validate the effectiveness of telehealth in other settings.
Source
A related resource from which the described resource is derived
Pediatr Transplant
. 2023 Mar 6;e14490. doi: 10.1111/petr.14490. Online ahead of print.
Language
A language of the resource
English
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://pubmed.ncbi.nlm.nih.gov/36763849/
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Title
A name given to the resource
Analysis of Survival Differences Between Cutaneous and Subcutaneous Malignant Peripheral Nerve Sheath Tumors
Creator
An entity primarily responsible for making the resource
Courtney M Kromer
Nour Yacoub
David Xiong
Thomas Knackstedt
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Malignant peripheral nerve sheath tumors (MPNSTs) are clinically aggressive soft tissue sarcomas that can present as cutaneous or subcutaneous based tumors that are commonly associated with neurofibromatosis type 1. Historically, these tumors have poor outcomes. Previously, no study has compared survival of cutaneous versus subcutaneous MPNSTs.
Objective: This study aims to investigate the difference in overall survival (OS) among cutaneous MPNSTs, subcutaneous MPNSTs of the head and neck, and subcutaneous MPNSTs of the trunk and extremities.
Materials and methods: Nine hundred eighteen patients were included in this retrospective study using the Surveillance, Epidemiology, and End-Results (SEER-9) database with primary cutaneous or subcutaneous MPNSTs from 1975 to 2016. OS was calculated using cox proportional hazard models for each group.
Results: No significant difference was revealed in OS between cutaneous or subcutaneous MPNSTs, regardless of location. Factors associated with decreased OS included advanced age, higher grade, and nondefinitive surgical modality.
Conclusion: This study results implies that unlike other soft tissue sarcomas, cutaneous presentation does not improve OS in patients with MPNSTs compared with their subcutaneous counterparts.
Source
A related resource from which the described resource is derived
Dermatol Surg
. 2023 Feb 10. doi: 10.1097/DSS.0000000000003717. Online ahead of print.
Language
A language of the resource
English
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1016/j.ajem.2023.01.049
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Title
A name given to the resource
The impact of COVID-19 on emergency department boarding and in-hospital mortality
Creator
An entity primarily responsible for making the resource
Gregory Griffin
Jessica Krizo
Caroline Mangira
Erin L Simon
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Introduction: The COVID-19 pandemic has been challenging for healthcare systems in the United States and globally. Understanding how the COVID-19 pandemic has impacted emergency departments (EDs) and patient outcomes in a large integrated healthcare system may help prepare for future pandemics. Our primary objective was to evaluate if there were changes to ED boarding and in-hospital mortality before and during the COVID-19 pandemic.
Methods: This was a retrospective cohort study of all patients ages 18 and over who presented to one of 17 EDs (11 hospital-based; 6 freestanding) within our healthcare system. The study timeframe was March 1, 2019- February 29, 2020 (pre-pandemic) vs. March 1, 2020-August 31, 2021 (during the pandemic). Categorical variables are described using frequencies and percentages, and p-values were obtained from Pearson chi-squared or Fisher's exact tests where appropriate. In addition, multiple regression analysis was used to compare ED boarding and in-hospital mortality pre-pandemic vs. during the pandemic.
Results: A total of 1,374,790 patient encounters were included in this study. In-hospital mortality increased by 16% during the COVID-19 Pandemic AOR 1.16(1.09-1.23, p < 0.0001). Boarding increased by 22% during the COVID-19 pandemic AOR 1.22(1.20-1.23), p < 0.0001). More patients were admitted during the COVID-19 pandemic than prior to the pandemic (26.02% v 24.97%, p < 0.0001). Initial acuity level for patients presenting to the ED increased for both high acuity (13.95% v 13.18%, p < 0.0001) and moderate acuity (60.98% v 59.95%, p < 0.0001) during the COVID-19 pandemic.
Conclusion: The COVID-19 pandemic led to increased ED boarding and in-hospital mortality.
Source
A related resource from which the described resource is derived
Am J Emerg Med
. 2023 Jan 30;67:5-9. doi: 10.1016/j.ajem.2023.01.049. Online ahead of print.
Language
A language of the resource
English
2023
boarding
COVID-19
Emergency department
Mortality
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://doi.org/10.1002/cam4.5466
Dublin Core
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Title
A name given to the resource
Cancer-related knowledge, beliefs, and behaviors among Hispanic/Latino residents of Indiana
Creator
An entity primarily responsible for making the resource
Manuel R Espinoza-Gutarra
Susan M Rawl
Gerardo Maupome
Heather A O'Leary
Robin E Valenzuela
Caeli Malloy
Lilian Golzarri-Arroyo
Erik Parker
Laura Haunert
David A Haggstrom
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Cancer is the leading cause of death for Hispanics in the USA. Screening and prevention reduce cancer morbidity and mortality.
Methods: This study administered a cross-sectional web-based survey to self-identified Hispanic residents in the state of Indiana to assess their cancer-related knowledge, beliefs, and behaviors, as well as to identify what factors might be associated with cancer screening and prevention. Chi-square and Fisher's exact test were used to compare associations and logistic regression used to develop both univariate and multivariate regression models.
Results: A total of 1520 surveys were completed, median age of respondents was 53, 52% identified as men, 50.9% completed the survey in Spanish, and 60.4% identified the USA as their country of birth. Most were not able to accurately identify ages to begin screening for breast, colorectal, or lung cancer, and there were significant differences in cancer knowledge by education level. US-born individuals with higher income and education more often believed they were likely to develop cancer and worry about getting cancer. Sixty eight percent of respondents were up-to-date with colorectal, 44% with breast, and 61% with cervical cancer screening. Multivariate models showed that higher education, lack of fatalism, older age, lower household income, and unmarried status were associated with cervical cancer screening adherence.
Conclusions: Among a Hispanic population in the state of Indiana, factors associated with cervical cancer screening adherence were similar to the general population, with the exceptions of income and marital status. Younger Hispanic individuals were more likely to be adherent with breast and colorectal cancer screening, and given the higher incidence of cancer among older individuals, these results should guide future research and targeted outreach.
Source
A related resource from which the described resource is derived
Cancer Med
. 2023 Jan 22. doi: 10.1002/cam4.5466. Online ahead of print.
Language
A language of the resource
English
2023
behaviors
Hispanic
Knowledge
screening
Survey
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1016/j.jemermed.2022.10.024
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Primary Neurologic Symptoms: Have You Considered Pernicious Anemia?
Creator
An entity primarily responsible for making the resource
Andrew D Yocum
Mili Patel
Bradley Palocko
Erin L Simon
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Vitamin B12, or cobalamin, is a nutrient that is vital for metabolic function. Absorption of ingested B12 is dependent on intrinsic factor, which is secreted by parietal cells within the stomach. Pernicious anemia is caused by an intrinsic factor deficiency or autoantibodies against intrinsic factor. The presence of parietal cell antibodies can destroy parietal cells, which can also lead to a deficiency in intrinsic factor. Both lead to megaloblastic anemia caused by vitamin B12 deficiency. The typical presentation of pernicious anemia includes fatigue, pale appearance, tingling sensation, depression, alterations to vision and smell, urinary incontinence, psychotic episodes, and weakness. The most effective treatment for pernicious anemia is intramuscular B12.
Case report: A 27-year-old woman with a history of vitiligo presented to the emergency department (ED) with bilateral lower extremity weakness, clumsiness, numbness, and tingling. Physical examination revealed ataxia, no sensation below her umbilicus, decreased strength, and hyperreflexia in both lower extremities. Complete blood count in the ED revealed low hemoglobin and hematocrit and elevated mean corpuscular volume, concerning for pernicious anemia. Further laboratory testing upon inpatient admission revealed a low vitamin B12 level and parietal cell antibodies in the blood. The patient's pernicious anemia was treated with intramuscular vitamin B12 injections, which led to near complete resolution of her symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early suspicion and detection of pernicious anemia in the ED can prevent serious and permanent hematologic and neurologic damage and the development of other autoimmune disorders.
Source
A related resource from which the described resource is derived
J Emerg Med
. 2023 Feb;64(2):217-219. doi: 10.1016/j.jemermed.2022.10.024. Epub 2023 Feb 2.
Language
A language of the resource
English
2023
megaloblastic anemia
neurologic symptoms
pernicious anemia
vitamin B12 deficiency
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1002/ski2.168
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Diagnosis of metaplastic synovial cysts in clinical dermatology
Creator
An entity primarily responsible for making the resource
Paayal S Vora
Sonam Rama
Stephen Olsen
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Metaplastic synovial cysts are a rare clinical finding, with less than 70 cases diagnosed to date. These cysts are painful and can greatly impact patients' quality of life. The goal of this case report is to describe the manifestations of these cysts to aid in clinical diagnosis and management. We herein report a case of a 58-year-old male who presented with a bump on the lateral left knee. He experienced pain upon walking. Notably, he had a past medical history of left knee replacement 15 years prior to presentation. Upon physical exam, the bump resembled a firm subcutaneous nodule. It was subsequently biopsied via eight-mm punch excision, revealing a metal portion of the patient's knee replacement; biopsy resulted in the removal of the entire bump. Biopsy results showed a cystic space in the deep dermis containing papillary villous projections consisting of fibrous cores, partially surfaced by a synovial-like lining. Based on these results, a metaplastic synovial cyst was diagnosed. The patient was referred to orthopaedic surgery for replacement to prevent recurrence, as the metal in the knee replacement was presumed the source of the cyst. The patient was then reassessed 3 months later, and he described resolution of his knee pain. Physical exam showed a well-healed linear scar. This patient's history and exam findings, along with the dermatopathology results, reflect the characteristic pattern in patients suffering from metaplastic synovial cysts. Prompt identification and subsequent removal can significantly improve patient's pain and ability to carry out daily activities.
Source
A related resource from which the described resource is derived
Skin Health Dis
. 2022 Sep 14;3(1):e168. doi: 10.1002/ski2.168. eCollection 2023 Feb.
Language
A language of the resource
English
2023
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1177/0271678X231156981
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Selenium supplementation provides potent neuroprotection following cerebral ischemia in mice
Creator
An entity primarily responsible for making the resource
Zhan Zhuo
Huimei Wang
Shuai Zhang
Perry F Bartlett
Tara L Walker
Sheng-Tao Hou
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Despite progress in reperfusion therapy, functional recovery remains suboptimal in many stroke patients, with oxidative stress, inflammation, dysbiosis, and secondary neurodegeneration constituting the major hurdles to recovery. The essential trace element selenium is emerging as a promising therapeutic agent for stroke. However, although several rodent studies have shown that selenium can protect against cell loss following cerebral ischemia, no study has yet examined whether selenium can enhance long-term functional recovery. Moreover, published studies have typically reported a single mechanism of action underlying selenium-mediated stroke recovery. However, we propose that selenium is more likely to have multifaceted actions. Here, we show that selenomethionine confers a potent neuroprotective effect in a canonical filament-induced transient middle cerebral artery occlusion (tMCAO) mouse model. Post-tMCAO selenium treatment significantly reduces the cerebral infarct volume, oxidative stress, and ferroptosis and enhances post-tMCAO motor performance in the acute phase after stroke. Moreover, analysis of the gut microbiota reveals that acute selenium treatment reverses stroke-induced gut dysbiosis. Longer-term selenium supplementation activates intrinsic neuroprotective mechanisms, prevents secondary neurodegeneration, alleviates systemic inflammation, and diminishes gut microbe-derived circulating trimethylamine N-oxide. These findings demonstrate that selenium treatment even after cerebral ischemia has long-term and multifaceted neuroprotective effects, highlighting its clinical potential.
Source
A related resource from which the described resource is derived
J Cereb Blood Flow Metab
. 2023 Feb 9;271678X231156981. doi: 10.1177/0271678X231156981. Online ahead of print.
Language
A language of the resource
English
2023
Ischemia/reperfusion injury
Neuroprotection
Oxidative Stress
selenium
stroke
trimethylamine N-oxide
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.1007/s00467-023-05893-2
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Cardiovascular implications of hypertensive autosomal dominant polycystic kidney disease: a systematic review and meta-analysis
Creator
An entity primarily responsible for making the resource
Rupesh Raina
Raghav Shah
Gordon Hong
Girish C Bhatt
Brian Abboud
Rohit Jain
Rahul Chanchlani
Siddharth Kumar Sethi
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Background: Autosomal dominant polycystic kidney disease (ADPKD) is among the most common inherited kidney diseases. Hypertension is a frequent cardiovascular manifestation, especially in adults, but elevated blood pressure is also found in children and adolescents. Acknowledgment of pediatric hypertension early is critical, as it can result in serious complications long-term if left undiagnosed.
Objective: We aim to identify the influence of hypertension on cardiovascular outcomes, mainly left ventricular hypertrophy, carotid intima media thickness, and pulse wave velocity.
Methods: We performed an extensive search on Medline, Embase, CINAHL, and Web of Science databases through March 2021. Original studies with a mix of retrospective, prospective, case-control studies, cross sectional studies, and observational studies were included in the review. There was no restriction on age group.
Results: The preliminary search yielded 545 articles with 15 articles included after inclusion and exclusion criteria. In this meta-analysis, LVMI (SMD: 3.47 (95% CI: 0.53-6.41)) and PWV (SMD: 1.72 (95% CI: 0.08-3.36)) were found to be significantly higher in adults with ADPKD compared to non-ADPKD; however, CIMT was not found to be significantly different. Also, LVMI was observed to be significantly higher among hypertensive adults with ADPKD (n = 56) as compared to adults without ADPKD (SMD: 1.43 (95% CI: 1.08-1.79)). Fewer pediatric studies were available with heterogeneity among patient populations and results.
Conclusions: Adult patients with ADPKD were found to have worse indicators of cardiovascular outcomes, including LVMI and PWV, as compared to non-ADPKD. This study demonstrates the importance of identifying and managing hypertension, especially early, in this population. Further research, particularly in younger patients, is necessary to further elucidate the relationship between hypertension in patients with ADPKD and cardiovascular disease.
Source
A related resource from which the described resource is derived
Pediatr Nephrol
. 2023 Feb 22. doi: 10.1007/s00467-023-05893-2. Online ahead of print.
Language
A language of the resource
English
2023
ADPKD
Cardiovascular
Carotid intima media thickness
Hypertension
Left ventricular mass index
Pediatrics
Pulse wave velocity
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.3390/jcm12051799
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Precision Medicine and the future of Cardiovascular Diseases: A Clinically Oriented Comprehensive Review
Creator
An entity primarily responsible for making the resource
Yashendra Sethi
Neil Patel
Nirja Kaka
Oroshay Kaiwan
Jill Kar
Arsalan Moinuddin
Ashish Goel
Hitesh Chopra
Simona Cavalu
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Cardiac diseases form the lion's share of the global disease burden, owing to the paradigm shift to non-infectious diseases from infectious ones. The prevalence of CVDs has nearly doubled, increasing from 271 million in 1990 to 523 million in 2019. Additionally, the global trend for the years lived with disability has doubled, increasing from 17.7 million to 34.4 million over the same period. The advent of precision medicine in cardiology has ignited new possibilities for individually personalized, integrative, and patient-centric approaches to disease prevention and treatment, incorporating the standard clinical data with advanced "omics". These data help with the phenotypically adjudicated individualization of treatment. The major objective of this review was to compile the evolving clinically relevant tools of precision medicine that can help with the evidence-based precise individualized management of cardiac diseases with the highest DALY. The field of cardiology is evolving to provide targeted therapy, which is crafted as per the "omics", involving genomics, transcriptomics, epigenomics, proteomics, metabolomics, and microbiomics, for deep phenotyping. Research for individualizing therapy in heart diseases with the highest DALY has helped identify novel genes, biomarkers, proteins, and technologies to aid early diagnosis and treatment. Precision medicine has helped in targeted management, allowing early diagnosis, timely precise intervention, and exposure to minimal side effects. Despite these great impacts, overcoming the barriers to implementing precision medicine requires addressing the economic, cultural, technical, and socio-political issues. Precision medicine is proposed to be the future of cardiovascular medicine and holds the potential for a more efficient and personalized approach to the management of cardiovascular diseases, contrary to the standardized blanket approach.
Source
A related resource from which the described resource is derived
J Clin Med
. 2023 Feb 23;12(5):1799. doi: 10.3390/jcm12051799.
Language
A language of the resource
English
2023
Cardiology
Heart failure
Hypertension
myocardial infarction
precision cardiology
Precision medicine
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://pubmed.ncbi.nlm.nih.gov/36915016/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Development of Imaging Criteria for Geriatric Blunt Trauma Patients
Creator
An entity primarily responsible for making the resource
Sami K Kishawi
Victoria J Adomshick
Penelope N Halkiadakis
Keira Wilson
Jordan C Petitt
Laura R Brown
Jeffrey A Claridge
Vanessa P Ho
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Introduction: Current decision tools to guide trauma computed tomography (CT) imaging were not validated for use in older patients. We hypothesized that specific clinical variables would be predictive of injury and could be used to guide imaging in this population to minimize risk of missed injury.
Methods: Blunt trauma patients aged 65 y and more admitted to a Level 1 trauma center intensive care unit from January 2018 to November 2020 were reviewed for histories, physical examination findings, and demographic information known at the time of presentation. Injuries were defined using the patient's final abbreviated injury score codes, obtained from the trauma registry. Abbreviated injury score codes were categorized by corresponding CT body region: Head, Face, Chest, C-Spine, Abdomen/Pelvis, or T/L-Spine. Variable groupings strongly predictive of injury were tested to identify models with high sensitivity and a negative predictive value.
Results: We included 608 patients. Median age was 77 y (interquartile range, 70-84.5) and 55% were male. Ground-level fall was the most common injury mechanism. The most commonly injured CT body regions were Head (52%) and Chest (42%). Variable groupings predictive of injury were identified in all body regions. We identified models with 97.8% sensitivity for Head and 98.8% for Face injuries. Sensitivities more than 90% were reached for all except C-Spine and Abdomen/Pelvis.
Conclusions: Decision aids to guide imaging for older trauma patients are needed to improve consistency and quality of care. We have identified groupings of clinical variables that are predictive of injury to guide CT imaging after geriatric blunt trauma. Further study is needed to refine and validate these models.
Source
A related resource from which the described resource is derived
J Surg Res
. 2023 Mar;283:879-888. doi: 10.1016/j.jss.2022.10.037. Epub 2022 Dec 7.
Language
A language of the resource
English
2023
Computed tomography imaging
Geriatrics
Missed injury
trauma
-
Hyperlink
A link, or reference, to another resource on the Internet.
URL
10.2337/dc22-0611
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The National Clinical Care Commission Report to Congress: Background, Methods, and Foundational Recommendations
Creator
An entity primarily responsible for making the resource
William H Herman
Ann Bullock
John M Boltri
Paul R Conlin
M Carol Greenlee
Aaron M Lopata
Clydette Powell
Howard Tracer
Dean Schillinger
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Description
An account of the resource
Since the first Federal Commission on Diabetes issued its report in 1975, the diabetes epidemic in the U.S. has accelerated, and efforts to translate advances in diabetes treatment into routine clinical practice have stalled. In 2021, the National Clinical Care Commission (NCCC) delivered a report to Congress that provided recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. In the five articles in this series, we present the NCCC's evidence-based recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. In this first article, we review the successes and limitations of previous federal efforts to combat diabetes. We then describe the establishment of and charge to the NCCC. We discuss the development of a hybrid conceptual model that guided the NCCC's novel all-of-government approach to address diabetes as both a societal and medical problem. We then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public and to conduct literature reviews. Finally, we review the NCCC's three foundational recommendations: 1) improve the coordination of non-health-related and health-related federal agencies to address the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensure that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensure that all federal policies and programs promote health equity in diabetes.
Source
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Diabetes Care
. 2023 Feb 1;46(2):e14-e23. doi: 10.2337/dc22-0611.
Language
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English
2023