scholarly journals Clinician-Reported Patient Awareness of Symptoms and Severity of Tardive Dyskinesia in Patients Prescribed VMAT2 Inhibitors

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 151-151
Author(s):  
Jonathan M. Meyer ◽  
Ericha Franey ◽  
Leslie Lundt ◽  
Betsy Benning ◽  
Edward Goldberg ◽  
...  
Keyword(s):  
Tardive Dyskinesia ◽  
Symptom Severity ◽  
Primary Care Physicians ◽  
Additional Data ◽  
Treatment Strategies ◽  
Vesicular Monoamine Transporter ◽  
Patient Awareness ◽  
Patient Demographics ◽  
The Past ◽  
Body Regions

AbstractObjectiveVesicular monoamine transporter 2 (VMAT2) inhibitors including valbenazine are first-line therapies for tardive dyskinesia (TD), a persistent movement disorder associated with antipsychotic exposure. This real-world study was performed to assess the association between patient awareness of TD symptoms and clinician-assessed symptom severity.MethodsClinicians who treated antipsychotic-induced TD with a VMAT2 inhibitor within the past 24 months were asked to extract demographic/clinical data from patients charts and complete a survey for additional data, including patient awareness of TD (yes/no) and TD symptom severity (mild/moderate/severe).ResultsData for 601 patients were provided by 163 clinicians (113 psychiatrists; 46 neurologists; 4 primary care physicians). Patient demographics: 50% male; mean age 50.6 years; 55% schizophrenia/schizoaffective disorder; 29% bipolar disorder; 16% other psychiatric diagnoses. Positive relationships were seen between patient awareness and clinician-assessed symptom severity. Awareness was highest in patients with severe symptoms in specific body regions: face (88% vs 78%/69% [awareness by severe vs moderate/mild symptoms]); jaw (90% vs 80%/67%); wrists (90% vs 69%/63%). In other regions, awareness was similar in patients with severe or moderate symptoms: lips (85%/86% vs 68% [severe/moderate vs mild]); tongue (81%/80% vs 73%); neck (80%/78% vs 68%); arms (67%/66% vs 62%); knees (67%/67% vs 53%).ConclusionsIn patients prescribed a VMAT2 inhibitor for TD, patient awareness was generally higher in those determined to have moderate-to-severe symptom severity as assessed by the clinician. More research is needed to understand how awareness and severity contribute to TD burden, and whether different treatment strategies are needed based on these factors.FundingNeurocrine Biosciences, Inc.

Recent Nanocarrier Approaches for Targeted Drug Delivery in Cancer Therapy

2020 ◽  
Vol 13 ◽  
Author(s):  
Rohit Bhatia ◽  
Amit Sharma ◽  
Raj Kumar Narang ◽  
Ravindra K. Rawal
Keyword(s):  
Drug Delivery ◽  
Polymeric Micelles ◽  
Mesoporous Silica Nanoparticles ◽  
Treatment Strategies ◽  
Human Beings ◽  
The Past ◽  
Organ Systems ◽  
Metal Organic ◽  
Continuous Progress ◽  
Chemotherapeutic Treatment

: Cancer is one of the most serious health concerns in 21st century whose prevalence is beyond boundaries and can affect any organ of human beings. The conventional chemotherapeutic treatment strategies lack specificity to tumours and are associated with toxic effects on immune system and other organ systems. In the past decades, there has been a continuous progress in the development of smart nanocarrier systems for target specific delivery of drugs against variety of tumours including intracellular gene-specific targeting. These nanocarriers are able to recognize the tumour cells and deliver the therapeutic agent in fixed proportions causing no or very less harm to healthy cells. Nanosystems have modified physicochemical properties, improved bioavailability and long retention in blood which enhances their potency. A huge number of nanocarrier based formulations have been developed and are in clinical trials. Nanocarrier systems include polymeric micelles, liposomes, dendrimers, carbon nanotubes, gold nanoparticles, etc. Recent advancements in nanocarrier systems include mesoporous silica nanoparticles (MSNs), metal organic frame works and quantum dots. In the present review, various nanocarrier based drug delivery systems along with their applications in the management of cancer have been described with special emphasis on MSNs.

scholarly journals AB0587 ASSESSING THE CHARACTERISTICS AND MANAGEMENT OF KNEE OSTEOARTHRITIS PATIENTS WITH HYPERTENSION BY CLINICIAN SPECIALITY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1330.2-1331
Author(s):  
D. Baldock ◽  
E. Baynton ◽  
C. F. Ng
Keyword(s):  
Knee Osteoarthritis ◽  
Sports Medicine ◽  
Primary Care Physicians ◽  
Bone Erosion ◽  
Holistic Treatment ◽  
Knee Oa ◽  
Patient Demographics ◽  
Medical Chart Review ◽  
Complex Patients ◽  
Minimum Number

Background:Though the pathogenesis of knee osteoarthritis (OA) is complex, patients with OA frequently have other comorbidities, including hypertension, which eludes to other considerations needed when deciding appropriate treatment management.Objectives:This study aims to examine the profiles of knee OA patients with hypertension vs. those without any comorbidities, and to elucidate key differences between these patient groups as potential areas of consideration.Methods:A multi-center, online medical chart review study of patients with OA was conducted between May – July 2020 among US rheumatologists (rheums), orthopedic surgeons (orthos), primary care physicians with a focus in sports medicine (SM PCPs), and pain specialists. Physicians recruited were screened for duration of practice in their specialty (3-50 years) and caseload (>=35 knee OA patients personally managed, at least 10 being moderate-severe). Patient charts were recorded for the next 5 eligible patients seen during the screening period. Respondents abstracted patient demographics and treatments used. Descriptive statistics were used to analyse the data.Results:260 physicians were recruited and collectively reported 796 knee OA patients; 559 were reported to experience hypertension whilst 237 were reported as not experiencing any comorbidities.Reported hypertension patients were significantly older (mean 67 vs 59 years old, respectively; p≤0.01) and weighed more (mean 82kg vs 77kg, respectively; p≤0.01) than patients without comorbidities; they were also significantly more likely to be previous smokers compared to those without comorbidities (23% vs 8%, respectively; p≤0.01). With regards to current knee OA severity, both orthos and SM PCPs reported a significantly higher proportion of hypertension patients that were deemed ‘severe’ (physician opinion) vs patients without comorbidities (orthos: 50% vs 32%, respectively; SM PCPs: 42% vs 23%, respectively; p≤0.01).Rheums and pain specialists reported greater mild opioid usage amongst hypertension patients compared to those without comorbidities (rheums: 28% vs 10%, respectively (p≤0.05); pain specialists: 40% vs 9%, respectively; (p≤0.01)); orthos and SM PCPs stated significantly greater use of corticosteroid injections amongst their reported hypertension patients vs those without comorbidities (orthos: 60% vs 41%, respectively; SM PCPs: 40% vs 19%, respectively; p≤0.01). Hypertension patients reported by orthos and SM PCPs are more likely to be considered for total knee replacement (TKR) surgery compared to those without comorbidities (orthos: 59% vs 32%, respectively; SM PCPs: 37% vs 19%, respectively; p≤0.01). Conversely, hypertension patients reported by rheums are less likely to be considered for TKR vs those without comorbidities (41% vs 18%, respectively; p≤0.05).Reported hypertension patients had a significantly higher mean Visual Analogue Scale for Pain (VAS) score than patients without comorbidities (6.6 vs 5.9, respectively; p≤0.01). A significantly higher proportion of patients with hypertension demonstrate radiographic evidence of bone erosion compared to those without comorbidities (69% vs 56%, respectively; p≤0.01).Conclusion:From the sample surveyed, knee OA patients with hypertension may require a more specific and holistic treatment approach that takes into account their CV status and managing physician specialty. Further investigation using comparator cohort is warranted.References:[1]Ipsos Osteoarthritis Therapy Monitor (May – July 2020, 260 specialists reporting on 769 knee OA patients seen in consultation, data collected online. Participating physicians were primary treaters and saw a minimum number of 35 knee OA patients). Data © Ipsos 2021, all rights reserved.[2]Ipsos Osteoarthritis Therapy Monitor (May – July 2020, 260 specialists reporting on 769 knee OA patients seen in consultation, data collected online. Participating physicians were primary treaters and saw a minimum number of 35 knee OA patients). Data © Ipsos 2021, all rights reserved.Disclosure of Interests:None declared.

Health Literacy in Primary Care: Reflections and Suggestions for Physicians, Researchers, and Administrators

2021 ◽  
pp. 155982762110412
Author(s):  
Anne Sprogell ◽  
Allison R. Casola ◽  
Amy Cunningham
Keyword(s):  
Primary Care ◽  
Health Literacy ◽  
Primary Care Physician ◽  
Healthcare System ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Health Records ◽  
The Past ◽  
Personal Bias ◽  
Concept Of Health

As the healthcare system evolves, it is becoming more complicated for physicians and patients. Patients might have had one doctor in the past, but now are likely to regularly see several specialists along with their primary care physician. Patients can access their health records online, which increases transparency and accountability, but adds more information they have to interpret. This is the concept of health literacy—the ability to obtain, process, and act upon information regarding one’s health. This article will characterize health literacy in primary care and provide three areas that primary care physicians and researchers can direct their focus in order to increase health literacy among patients: community engagement, trainee education, and examination of personal bias.

TNF-Alpha Inhibitors and Ustekinumab for the Treatment of Psoriasis: Therapeutic Utility in the Era of IL-17 and IL-23 Inhibitors

2022 ◽  
pp. 247553032110474
Author(s):  
Julie J. Hong ◽  
Edward K. Hadeler ◽  
Megan L. Mosca ◽  
Nicholas D. Brownstone ◽  
Tina Bhutani ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
Risk Patient ◽  
Tnf Alpha ◽  
Inflammatory Condition ◽  
Biologic Therapies ◽  
Malignancy Risk ◽  
Patient Demographics ◽  
The Past ◽  
Chronic Inflammatory Condition ◽  
Patient Subgroups

Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and comorbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.

Approaches to and Treatment Strategies for Playing-Related Pain Problems Among Czech Instrumental Music Students: An Epidemiological Study

2015 ◽  
Vol 30 (3) ◽  
pp. 135-142 ◽  
Author(s):  
Christos I Ioannou ◽  
Eckart Altenmuller
Keyword(s):  
Instrumental Music ◽  
Transition Period ◽  
Treatment Strategies ◽  
Music Students ◽  
Additional Insight ◽  
Medical Treatments ◽  
Treatment Methods ◽  
Body Regions ◽  
Physical Exercises ◽  
Paper Questionnaire

The current study examined the severity of playing-related pain (PRP) problems among music students at the Prague State Conservatoire, as well as the various treatment methods used by these students and how they approach and deal with these phenomena while studying. In total, 180 instrumental students participated and completed a paper questionnaire. Of these, 88.9% reported that they had experienced PRP at least once in their lives, with 12.6% experiencing pain every time they play. The onset of PRP seemed to coincide with the transition period on entry to the conservatoire and was associated with the increase in hours of practice. Specific body regions associated with playing each particular instrument were most frequently affected, with females being more susceptible than males to the development of PRP. An alarming 35% of the affected students tended not to seek help at all, whereas those who did tended to seek advice first from their instrument tutor and second from medical doctors. Most students who visited doctors reported that medical treatments only partially helped them to overcome PRP problems. The most frequent treatment methods used were resting, gel or creams, and physical exercises. Students believed that inappropriate posture played a key role in the development of their PRP problems. Finally, students indicated a willingness to be aware of and educated about PRP issues during their studies. Further exploration of PRP problems among student musicians is warranted. Better understanding of differing attitudes toward, use of, and efficiency of various treatment methods after the occurrence of PRPs will provide additional insight for prevention and treatment.

scholarly journals Antithrombotic Treatment After Coronary Intervention: Agreement and Controversy

2020 ◽  
Vol 15 ◽  
Author(s):  
Tamara García Camarero ◽  
José M de la Torre Hernández
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
New Drugs ◽  
Antithrombotic Treatment ◽  
The Past ◽  
Percutaneous Coronary ◽  
The Subject ◽  
Clinical Conditions ◽  
Combination Regimens

Percutaneous revascularisation has evolved dramatically in the past few decades. The approach to the management of ischaemic heart disease has changed due to the development of new devices and techniques as well as the availability of new drugs and treatment strategies. Its use in combination with antiplatelet therapies has been essential to protect against stent thrombosis. The length of time this combination therapy is used has been modified in recent years and has been the subject of extensive research. The effect of prolonging the time it is taken or shortening it has been evaluated in different clinical conditions. In practice, the decisions regarding antithrombotic therapy after percutaneous coronary intervention are informed by the patient’s profile and the characteristics of the procedures performed. In this article, we review the use of antiplatelet/anticoagulant therapy after percutaneous coronary intervention focusing on trials and guidelines addressing variable durations for combination regimens and the alternatives.

scholarly journals Patterns of Change in ACGME-Accredited Residency Programs and Positions: Implication for the Adequacy of GME Positions and Supply of Physicians in the United States

2014 ◽  
Vol 6 (2) ◽  
pp. 399-403 ◽  
Author(s):  
Kathleen D. Holt ◽  
Rebecca S. Miller ◽  
Ingrid Philibert ◽  
Thomas J. Nasca
Keyword(s):  
Medical Education ◽  
Medical School ◽  
Graduate Medical Education ◽  
Primary Care Physicians ◽  
Population Data ◽  
The United States ◽  
Graduate Medical ◽  
The Past ◽  
Accredited Institutions ◽  
The Impact

Abstract Background Recent studies suggest that the supply of primary care physicians and generalist physicians in other specialties may be inadequate to meet the needs of the US population. Data on the numbers and types of physicians-in-training, such as those collected by the Accreditation Council for Graduate Medical Education (ACGME), can be used to help understand variables affecting this supply. Objective We assessed trends in the number and type of medical school graduates entering accredited residencies, and the impact those trends could have on the future physician workforce. Methods Since 2004, the ACGME has published annually its data on accredited institutions, programs, and residents to help the graduate medical education community understand major trends in residency education, and to help guide graduate medical education policy. We present key results and trends for the period between academic years 2003–2004 and 2012–2013. Results The data show that increases in trainees in accredited programs are not uniform across specialties, or the types of medical school from which trainees graduated. In the past 10 years, the growth in residents entering training that culminates in initial board certification (“pipeline” specialties) was 13.0%, the number of trainees entering subspecialty education increased 39.9%. In the past 5 years, there has been a 25.8% increase in the number of osteopathic physicians entering allopathic programs. Conclusions These trends portend challenges in absorbing the increasing numbers of allopathic and osteopathic graduates, and US international graduates in accredited programs. The increasing trend in subspecialization appears at odds with the current understanding of the need for generalist physicians.

Functionally Crippled Nose

2020 ◽  
Vol 36 (01) ◽  
pp. 066-071
Author(s):  
Priyesh Patel ◽  
Sam P. Most
Keyword(s):  
Nasal Obstruction ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Objective Measure ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Facial Plastic

AbstractNasal obstruction is a common presenting symptom of patients seen by primary care physicians, otolaryngologists, and facial plastic surgeons. A variety of treatment strategies, both surgical and nonsurgical, have been used with success in improving nasal obstruction and quality of life. In a subset of patients, many of whom have either attempted these common treatment strategies or are intolerant of them, nasal obstruction remains a significant symptom. In these patients, there may be an identifiable problem, but it is simply not repairable or there is no identifiable anatomic issue. The management of these patients is discussed in this article, with an emphasis on a sensitive approach that takes into consideration a patient's mental health. While the need for diagnostic testing is generally not necessary for most cases of nasal obstruction, endoscopy and imaging should be considered in these patients. Validated patient-reported outcome measures are particularly helpful in providing an objective measure to a patient's frustrating symptoms. A variety of medications can be either contributory to the patient's symptoms or therapeutic if used appropriately. A variety of surgical interventions can also result in a functionally crippled nose and diagnoses including nasal valve stenosis, septal perforations, and empty nose syndrome are discussed. Importantly, further surgical interventions may not be appropriate if a deformity is minimal, and a surgeon should resist the temptation to proceed with surgery in those situations.

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