AN AUDIT TO COMPARE DISCHARGE RATES BETWEEN ANTIDEPRESSANT MONOTHERAPIES PRESCRIBED FOR PURE UNIPOLAR DEPRESSION VERSUS DEPRESSION IN THE PRESENCE OF OTHER INDICATIONS

Introduction: It has been demonstrated that there are differences in the efficacy and acceptability of commonly prescribed antidepressants (Cipriani et al. 2009). This meta-analysis showed that escitalopram, sertraline, venlafaxine and mirtazapine were the most effective in the acute treatment of unipolar depression in adults. In this audit, these most effective antidepressants will be referred to as ‘the four’, whilst other antidepressants will be referred to as ‘the others’. We aimed to analyse prescribing patterns of antidepressant monotherapies in Bedford East Community Mental Health Team. We also aimed to compare the efficacy of antidepressant monotherapies in patients with unipolar depression or patients with depressed mood and also other psychiatric indications within Bedford East Community Mental Health Team, using discharge rates from the out-patient clinic as the outcome measure. We aimed to compare the efficacy of ‘the four’ versus ‘the others’ in patients with unipolar depression patients with depressed mood and also other psychiatric indications at within Bedford East Community Mental Health Team , using discharge rates from the out-patient clinic as the outcome measure. Subjects and Methods: We included all patients on an antidepressant monotherapy in Bedford East Community Mental Health Team in our analysis (206 patients in total) (Figure 1). We examined the clinical notes for each patient to assess whether they were diagnosed with unipolar depression or another psychiatric condition, and whether they had been discharged from the out-patient clinic after being prescribed the antidepressant. This allowed us to calculate discharge rates for each antidepressant monotherapy. Results: For patients with unipolar depression, discharge rates were higher when they were prescribed one of ‘the four’ and highest when prescribed escitalopram. For patients with other indications, discharge rates were higher for ‘the others’ and highest for fluoxetine . Discussion: A greater percentage of patients with unipolar depression were discharged from clinic compared with patients treated with antidepressant monotherapy for depressed mood and also other psychiatric indications. Conclusion: These results suggest that co-morbid undiagnosed other mental illness may be a cause of ‘resistant depression’

The Grizzly, September 21, 2023

Rush Week 2023 • Sudoku • Fall Student Engagement Events • More IIE Events This Semester • Prints and Imprints Left Behind - at the Berman • Student Responses to Changes to Good Samaritan Policy • Have You Ever Played Rugby? • Ursinus Introduces Temporary Expansion to the Wellness Center: The Hive (A Thread)https://digitalcommons.ursinus.edu/grizzlynews/2015/thumbnail.jp

AN AUDIT TO COMPARE DISCHARGE RATES AND SUICIDALITY BETWEEN ANTIDEPRESSANT MONOTHERAPIES PRESCRIBED FOR UNIPOLAR DEPRESSION

Introduction: It has been demonstrated that there are differences in efficacy and acceptability of commonly prescribed antidepressants (Cipriani et al. 2009). This meta-analysis showed that escitalopram, sertraline, venlafaxine and mirtazapine were the most effective antidepressant monotherapies in the acute treatment of unipolar depression in adults. We aimed to analyse prescribing patterns of antidepressant monotherapies in Bedford Hospital. We intended to compare the efficacy of antidepressant monotherapies in patients with unipolar depression at Bedford East CMHT, using discharge rates and rates of reduced suicidality (including suicidal ideation and Behaviour) after treatment by the CMHT as the outcome measure. We also decided to compare the efficacy of ‘the four’ versus ‘the others’ in patients with unipolar depression in Bedford East CMHT, using discharge rates and rates of reduced suicidality (including suicidal ideation and Behaviour) after treatment by the CMHT as the outcome measures. Subjects and Methods: We identified and included all patients with unipolar depression prescribed an antidepressant monotherapy in Bedford East CMHT. We identified patients who were discharged after treatment, as well as patients who were suicidal before treatment, and after treatment. Hence we could work out discharge rates and reduction in suicide rates for each antidepressant monotherapy. These were then compared, using graphs. Results: The most frequently prescribed antidepressant monotherapy was citalopram. Prescription of ‘the four’ was associated with a greater percentage of patients discharged from the clinic than ‘the others’. Sertraline was the antidepressant most likely to reduce suicidality in our sample. Discussion: This audit in a small group of patients suggests that prescription of ‘the four’ leads to a higher discharge rate than ‘the others’. Regarding suicidality, this audit in a small group of patients suggests that sertraline is the most effective antidepressant monotherapy in reducing suicidality in patients with unipolar depression. Conclusion: The study has several limitations, however it does appear that the antidepressants identified by Cipriani are effective compared with other monotherapies. We recommend that all CMHTs should carry out audits of their prescribing practice

Keratinocyte growth factor for the treatment of the acute respiratory distress syndrome (KARE): a randomised, double-blind, placebo-controlled phase 2 trial

<p>(<b>A</b>) Immunofluorescence signal for dystrophin is significantly reduced in the SSI heart (bottom left panel) compared with the immunofluorescent signal in the SHAM heart (upper left panel), and the SHAM+ALLN (upper right panel) and SSI+ALLN (bottom right panel) myocardium. (<b>B</b>) Protein levels of dystrophin in the SHAM, SSI, SHAM+ALLN and SSI+ALLN hearts were measured 24 h after the CLP procedure and were expressed in arbitrary units (AUs). α-Tubulin was used to determine equivalent loading conditions. The results (n = 6 per group) are representative of three different experiments. Scale bars indicate 50 μm.</p

Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-E5103

Purpose: Racial disparity in breast cancer outcomes exists between African American and Caucasian women in the United States. We have evaluated the impact of genetically determined ancestry on disparity in efficacy and therapy-induced toxicity for breast cancer patients in the context of a randomized, phase III adjuvant trial. Patients and Methods: This study compared outcomes between 386 patients of African ancestry (AA) and 2473 patients of European ancestry (EA) in a randomized, phase III breast cancer trial; ECOG-ACRIN-E5103. The primary efficacy endpoint, invasive disease free survival (DFS) and clinically significant toxicities were compared including: anthracycline-induced congestive heart failure (CHF), taxane-induced peripheral neuropathy (TIPN), and bevacizumab-induced hypertension. Results: Overall, AAs had significantly inferior DFS (p=0.002; HR=1.5) compared with EAs. This was significant in the estrogen receptor-positive subgroup (p=0.03); with a similar, non-significant trend for those who had triple negative breast cancer (TNBC; p=0.12). AAs also had significantly more grade 3-4 TIPN (OR=2.9; p=2.4 ×10-11) and grade 3-4 bevacizumab-induced hypertension (OR=1.6; p=0.02), with a trend for more CHF (OR=1.8; p=0.08). AAs had significantly more dose reductions for paclitaxel (p=6.6 ×10-6). In AAs, dose reductions in paclitaxel had a significant negative impact on DFS (p=0.03); whereas in EAs, dose reductions did not impact outcome (p=0.35). Conclusion: AAs had inferior DFS with more clinically important toxicities in ECOG-ACRIN-E5103. The altered risk to benefit ratio for adjuvant breast cancer chemotherapy should lead to additional research with the focus centered on the impact of genetic ancestry on both efficacy and toxicity. Strategies to minimize dose reductions for paclitaxel, especially due to TIPN, are warranted for this population

Charcot-Marie-Tooth gene, SBF2, associated with taxaneinduced peripheral neuropathy in African Americans

PURPOSE: Taxane-induced peripheral neuropathy (TIPN) is one of the most important survivorship issues for cancer patients. African Americans (AA) have previously been shown to have an increased risk for this toxicity. Germline predictive biomarkers were evaluated to help identify a priori which patients might be at extraordinarily high risk for this toxicity. EXPERIMENTAL DESIGN: Whole exome sequencing was performed using germline DNA from 213 AA patients who received a standard dose and schedule of paclitaxel in the adjuvant, randomized phase III breast cancer trial, E5103. Cases were defined as those with either grade 3-4 (n=64) or grade 2-4 (n=151) TIPN and were compared to controls (n=62) that were not reported to have experienced TIPN. We retained for analysis rare variants with a minor allele frequency <3% and which were predicted to be deleterious by protein prediction programs. A gene-based, case-control analysis using SKAT was performed to identify genes that harbored an imbalance of deleterious variants associated with increased risk of TIPN. RESULTS: Five genes had a p-value < 10-4 for grade 3-4 TIPN analysis and three genes had a p-value < 10-4 for the grade 2-4 TIPN analysis. For the grade 3-4 TIPN analysis, SET binding factor 2 (SBF2) was significantly associated with TIPN (p-value=4.35 x10-6). Five variants were predicted to be deleterious in SBF2. Inherited mutations in SBF2 have previously been associated with autosomal recessive, Type 4B2 Charcot-Marie-Tooth (CMT) disease. CONCLUSION: Rare variants in SBF2, a CMT gene, predict an increased risk of TIPN in AA patients receiving paclitaxel

Assessing the umbrella value of a range-wide conservation network for Jaguars (Panthera onca)

Umbrella species are employed as conservation short-cuts for the design of reserves or reserve networks. However, empirical data on the effectiveness of umbrellas is equivocal, which has prevented more widespread application of this conservation strategy. We perform a novel, large-scale evaluation of umbrella species by assessing the potential umbrella value of a jaguar (Panthera onca) conservation network (consisting of viable populations and corridors) that extends from Mexico to Argentina. Using species richness, habitat quality, and fragmentation indices of similar to 1500 co-occurring mammal species, we show that jaguar populations and corridors overlap a substantial amount and percentage of high-quality habitat for co-occurring mammals and that the jaguar network performs better than random networks in protecting high-quality, interior habitat. Significantly, the effectiveness of the jaguar network as an umbrella would not have been noticeable had we focused on species richness as our sole metric of umbrella utility. Substantial inter-order variability existed, indicating the need for complementary conservation strategies for certain groups of mammals. We offer several reasons for the positive result we document, including the large spatial scale of our analysis and our focus on multiple metrics of umbrella effectiveness. Taken together, our results demonstrate that a regional, single-species conservation strategy can serve as an effective umbrella for the larger community and should help conserve viable populations and connectivity for a suite of co-occurring mammals. Current and future range-wide planning exercises for other large predators may therefore have important umbrella benefits

Perifosine plus lenalidomide and dexamethasone in relapsed and relapsed/refractory multiple myeloma: a Phase I Multiple Myeloma Research Consortium study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92443/1/bjh9173.pd