Long-term oral blonanserin treatment for schizophrenia: a review of Japanese long-term studies

In general, the course of schizophrenia is chronic accompanied not only by positive and negative symptoms but also by cognitive dysfunction associated with psychosocial disability, and thus treatment combining antipsychotics and psychological therapy is considered promising. This review focused on two prospective, open-label, multicenter, phase 3 long-term studies for approval of oral blonanserin for the treatment of schizophrenia. These two studies included both inpatients and outpatients with variable disease duration or symptom prominence according to the Positive and Negative Syndrome Scale (PANSS). The selected two studies consisted of almost the same study schedule and eligibility criteria but different protocols regarding prior medications and concomitant antipsychotics. The proportion of patients who had a baseline PANSS negative score higher than the positive score was 82.2 and 67.2% in the two studies. In both studies, patients with an illness duration of ≥ 10 years were the most common. Based on the clinical symptoms at baseline, the physician determined the treatment: blonanserin monotherapy, blonanserin in combination with the existing antipsychotic medication, or therapy simplified to haloperidol together with blonanserin. The 28-week completion rate for long-term blonanserin treatment was high in both studies (82.2 and 78.7%). The types of adverse events in both studies were similar to those in the preceding 8-week randomized, active-controlled studies in Japan, which were included in the application package for the approval of oral blonanserin for patients with schizophrenia. Long-term blonanserin use did not increase the risk of extrapyramidal symptoms but reduced the dose of antiparkinsonian drugs, minimally affecting functioning. In both studies, the PANSS total score, positive score, and negative score were improved at the last observation carried forward compared with those at baseline. In conclusion, blonanserin is useful for long-term treatment of chronic schizophrenic patients when the appropriate management of clinical symptoms and adverse drug reactions are applied. Blonanserin might represent a promising treatment option that partially or completely relieves patients with chronic schizophrenia of polypharmacy. Blonanserin may possibly fit both the current real-world clinical setting and the currently recommended approach to antipsychotic medication.

Evaluation of Plasmatic Procalcitonin in Healthy, and in Systemic Inflammatory Response Syndrome (SIRS) Negative or Positive Colic Horses

Colic horses show systemic inflammatory response syndrome (SIRS) clinical signs. Procalcitonin (PCT) showed increased circulating levels in sick horses. This study compares plasma PCT concentrations in healthy vs. SIRS negative/positive colic horses over time, and evaluates PCT and SIRS score potential correlation, to verify the usefulness of PCT for the evaluation of SIRS severity. Ninety-one horses were included; 43/91 were healthy, on basis of physical examination, blood work and SIRS score (score = 0), while 48/91 were sick colic horses, classified as SIRS-negative (score < 2) and positive (score ≥ 2). Moreover, a 0–6 point-scale SIRS score was calculated (assessing mucous membrane color and blood lactate concentration). PCT was evaluated at admission, and at 24, 48, 72 and 96 h, using a commercial kit for equine species. We verified by the ANOVA test PCT differences between healthy vs. colic horses, healthy vs. SIRS-negative or SIRS-positive colic horses, at all sampling times, and the correlation between the SIRS score at admission with the SIRS score. Statistically significant differences were detected between healthy vs. all colic horses and between healthy vs. SIRS-positive or negative horses at all sampling times. No correlation was observed between the SIRS score at admission and PCT values. PCT was statistically higher in colic horses compared to the healthy ones, suggesting a role as a biomarker for colic.

Abstract 12818: Identifying Drivers of Hospital Readmission Through Analysis of Discrepant Predicted and Observed Readmission Status

Introduction: The Hospital Readmissions Reduction Program (HRRP) lowers Medicare payments to hospitals with excess readmissions for certain conditions. We analyzed FY2020 HRRP data for Brigham and Women’s Hospital (July 2015 to June 2018). We conducted an analysis to identify patients with a discrepant expected vs observed readmission status for AMI, HF and CABG, followed by a chart review to explain this discrepancy. Methods: We calculated the risk of readmission for each patient, which was a summed value of the weights associated with all recorded comorbidities in the CMS data. A negative risk score indicated a patient was unlikely to be readmitted and a positive score indicated the opposite. We then performed a chart review focused on patients who had a high risk of readmission but were not readmitted, and those who had a low risk of readmission but were readmitted. Results: For AMI, 18% (108/596) of patients were readmitted within 30 days, CABG 14% (50/357) of patients, and HF 27% (367/1382) of patients. For AMI, risk of readmission scores ranged from 2.75 to -0.095. 5/596 patients had a negative score, and none were readmitted. For CABG, scores ranged from 2.64 to -0.31, 58/357 people had a negative score, and 6 were readmitted. For HF, scores ranged from 1.94 to 0.055. There were no negative scores, but of the lowest 20/1382 scores, 2 were readmitted. We then performed a chart review of 37 patients whose readmission status was discordant with their risk score, and examined why this occurred. For patients who were low risk but were readmitted across all three conditions, 30% (range 10% - 54%) did not have a follow up appointment scheduled before discharge, 11% (range 0% - 29%) did not have an advanced care plan and 95% (range 86% - 100%) had not had a SIC. Patients who were high risk but not readmitted were evaluated but did not have any notable characteristics. We did not find any evidence of under-coding of risk comorbidities that would have led to falsely low risk scores. Conclusions: Patients with more comorbidities were more likely to get readmitted, and we found these risk factors to be accurately recorded. Clinical care insights from this project include the need for more SICs and palliative care consults and a more targeted effort to ensure patients have appropriate follow-up.

Integration of service quality, benchmarking and Ishikawa diagram in service operations

<p>This paper aims to explore the integration of Service Quality (SERVQUAL) and two specific Total Quality Management (TQM) techniques -benchmarking and Ishikawa diagram- to improve quality in the service industry, particularly in the hospitality industry. The survey was administered to respondents at one five-star hotel in Bandung City, Indonesia. Benchmarking was conducted to compare this hotel to two other hotels at similar levels and within geographical proximity. Ishikawa analysis was then performed to analyze potential causes. The results of the study identified eleven negative score attributes (out of twenty-one) from SERVQUAL, which was in line with the benchmarking results. The Ishikawa diagram showed the root causes of these attributes and helped with developing ideas for practical quality improvements in the future. Most studies in the hospitality industry have examined SERVQUAL and TQM separately. Our study contributes uniquely to the existing literature by providing insight into the combination of SERVQUAL and two TQM specific tools to improve quality operations in a hospitality setting.</p>

Aplicación de un calendario de pruebas de evaluación continua en la asignatura “Obstetricia” en sexto de Medicina

Introducción. Con el objetivo de promover y motivar al aprendizaje continuo durante el curso de la asignatura de Obstetricia (6º Medicina), se diseñó un calendario de “Pruebas de Evaluación Continua” (PEC). Este aprendizaje progresivo permite interiorizar conceptos, mejor seguimiento de las clases sucesivas y facilita el estudio, mejorando el rendimiento final. Métodos. Se diseñaron 4 PEC voluntarias, una por bloque del temario, con 10 preguntas tipo test sin puntuación negativa por error, para estimular al alumnado a pensar en cada una de las cuestiones y tomar decisiones. Las PEC se realizaron en los últimos 10 minutos de la última clase de cada bloque. Medicina tiene cinco grupos, uno por hospital docente. Esta iniciativa se realizó sólo en uno de los grupos (grupo A). Resultados. Se presentaron a las PEC el 90,9% de los alumnos matriculados. En la primera PEC la calificación media fue 68% (máximo 90%; mínimo 50%; moda 70%), en la segunda 88% (máximo 100%; mínimo 60%; moda 90%), en la tercera 95% (máximo 100%; mínimo 80%; moda 100%) y en la cuarta 99% (máximo 100%; mínimo 90%, moda 100%). La calificación media en el examen final de la asignatura (común a los 5 grupos) del grupo A fue de 7,300 (sobre 10), superior a la de los grupos B (6,886), C (6,592), D (6,572) y E (6,463). Conclusiones. Se objetivó un aumento del rendimiento progresivo grupal e individual. Los resultados de la primera PEC fueron más dispersos, y posteriormente se fueron homogeneizando. El grupo en el que se realizaron las PEC obtuvo mejor resultado en el examen final que los otros grupos. Abstract: Introduction. We designed a “Continuous Assessment Tests” (CAT) for promoting and motivating continuous learning during the course of the subject “Obstetrics” (6th year of Medicine). This progressive learning enables concepts to be internalized, better monitoring of successive classes and facilitates study, improving results. Methods. Four voluntary CAT were designed, one per block of the subject, with 10 multiple choice questions without negative score by mistake to stimulate students to think about each of the questions and make decisions. The CAT were performed in the last 10 minutes of the last class of each block. Medicine has five groups, one per teaching hospital. This initiative was carried out in only one of the groups (group A). Results. 90.9% of the enrolled students attended the CAT. In the first CAT the mean score was 68% (maximum 90%; minimum 50%; mode 70%), in the second 88% (maximum 100%; minimum 60%; mode 90%), in the third 95% (maximum 100%; minimum 80%; mode 100%) and in the fourth 99% (maximum 100%; minimum 90%, mode 100%). The mean score in the final exam of the subject (common to the 5 groups) of group A was 7,300 (out of 10), higher than that of groups B (6,886), C (6,592), D (6,572) and E (6,463). Conclusions. An increase in group and individual progressive yield was observed. The results of the first CAT were more dispersed, and later they were homogenized. The group in which the CAT were performed got better yield in the final exam than the other groups.

DISABILITY AND EXECUTIVE FUNCTIONS IN SCHIZOPHENIA: A CROSSSECTIONAL STUDY. (RELATION BETWEEN DISABILITY AND POSITIVE, NEGATIVE SYMPTOMS)

The aim of the study was to see if there is any association between disability, positive- negative symptoms in patients of schizophrenia. Study had a crossectional design with purposive sampling in 50 patients with schizophrenia. Subjects were assessed using sociodemographic and clinical data sheet, PANSS, IDEAS (disability) . The result of the study revealed a significant association was seen between IDEAS and WCST variables in patients of schizophrenia. A significant association was also seen between PANSS (positive and negative score) with IDEAS and WCST variables (disability and executive functions being more strongly associated with negative symptoms). On correlation analysis of socio-demographic and clinical data with IDEAS and WCST variables, a significant correlation (positive) of age and duration of illness was seen with IDEAS. Executive functions and negative symptoms are crucial for functional outcome and independent living and are important target for intervention in order to reduce disability and improve quality of life in patients suffering from Schizophrenia. Keywords: Schizophrenia, Disability, Positive–negative symptoms, Executive functions.

DISABILITY AND EXECUTIVE FUNCTIONS IN SCHIZOPHENIA: A CROSSSECTIONAL STUDY. (RELATION OF DISABILITY WITH EXECUTIVE FUNCTIONS)

The aim of the study was to see if there is any association between disability, positive- negative symptoms and executive functions in patients of schizophrenia. Study had a crossectional design with purposive sampling in 50 patients with schizophrenia. Subjects were assessed using sociodemographic and clinical data sheet, PANSS, IDEAS (disability) and WCST (executive functions). The result of the study revealed that poor executive functioning is responsible for functional impairment in patients with schizophrenia. A significant association was seen between IDEAS and WCST variables in patients of schizophrenia. A significant association was also seen between PANSS (positive and negative score) with IDEAS and WCST variables (disability and executive functions being more strongly associated with negative symptoms). On correlation analysis of socio-demographic and clinical data with IDEAS and WCST variables, a significant correlation (positive) of age and duration of illness was seen with IDEAS. Age and drug dosage were having significant (positive) correlation with WCST variable and education was found to be having significant (negative) correlation with WCST variables. Executive functions and negative symptoms are crucial for functional outcome and independent living and are important target for intervention in order to reduce disability and improve quality of life in patients suffering from Schizophrenia. Keywords: Schizophrenia, Disability, Positive–negative symptoms, Executive functions.

Public engagement in health technology assessment in Brazil: the case of the Trastuzumab public consultation

Background Public engagement in health technology assessment (HTA) is increasing worldwide. There are several forms of public engagement and it is not always possible to determine which stakeholders participate in the HTA process and how they contribute. Our objective was to investigate which types of social representatives contributed to the public consultation on the incorporation of Trastuzumab for early-stage breast cancer treatment within the public health system in Brazil, held in 2012 by the National Committee for Health Technology Incorporation (CONITEC). Methods A mixed methods approach was used to analyze social representativeness and the composition of the corpus from the public consultation, which consisted of 127 contributions. Three types of analysis were performed using IRaMuTeQ software: classic lexical analysis, descending hierarchical classification and specificities analysis. The contributions were clustered according to the main categories of discourse observed, into four social representation categories: 1) patient representation/advocacy; 2) pharmaceutical industry/advocacy; 3) healthcare professionals; and 4) individual contributions. Results Category 1 contained words related to increased survival due to use of the drug and a low score for words pertaining to studies on Trastuzumab. The word “safety” obtained a positive score only in category 2, which was also the only category that exhibited a negative score for the word “risk”. Category 3 displayed the lowest scores for “diagnosis” and “safety”. The word “efficacy” had a negative score only in category 4. Conclusions Each category exhibited different results for words related to health systems and to key concepts linked to HTA. Our analysis enabled the identification of the most prominent contributions for each category. Despite the promising results obtained, further research is needed to validate this software for use in analyzing public contributions.

Lessons learned from performance of students of Pharmacology in self coded surprise test with negative marking.

Introduction: The present study aims to find the effect of instruction of negative marking in a self-coded MCQ examination on the performance of students in the subject of Pharmacology with respect to the raw score, correct score and negative score. Material and methods: This longitudinal study was conducted in the Department of Pharmacology, Rural Medical College, Loni. The Second MBBS students were exposed to a self-coded MCQ test twice by surprise. The first test (T1) was given without instructions of negative marking, while during the second test (T2) instructions for negative marking were given. The parameters of the raw score, negative score, corrected score and number of students who did not attempt respective MCQs were calculated. The number of students passing with modified Minimum Passing Level was calculated was compared with conventional Minimum Passing Level. Results: Sixty-seven students participated in the study. There was a statistically significant decrease in the raw score in the T2, while the increase in the negative score when compared with T1. The number of non-attempted questions was increased in T2. There was a statistically significant difference in the number of students passed with respect to raw score in T1 and T2, while no such difference was seen with respect to Negative score and Corrected score. Conclusion: The Corrected score and Negative score are not affected by the minimum passing level, indicating a better parameter of scoring than the raw score. Hence, the use of Negative score or Corrected score should be encouraged than the use of conventional Raw score. Keywords: Minimum Passing Level, Negative Marking, MCQ, Corrected score, Pharmacology, Formative assessment, surprise test, self-coded test.