The effect of lamotrigine augmentation of clozapine in a sample of treatment-resistant schizophrenic patients: A double-blind, placebo-controlled study

Based on the evidence that lamotrigine added to clozapine in refractory schizophrenic patients has reported promising results, the present 24-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and neurocognitive assessments patients were randomly allocated to receive, in a double-blind design, either up to 200 mg/day of lamotrigine or a placebo. A final sample of fifty-one patients completed the study. The results obtained indicate that lamotrigine added to stable clozapine treatment showed a beneficial effect on the negative, positive and general psychopathological symptomatology in a sample of treatment-resistant schizophrenic patients. Regarding cognitive functions, improvement was observed in some explored areas, such as attentional resistance to interference, verbal fluency and executive functioning. The findings provide evidence that lamotrigine augmentation of clozapine treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant schizophrenia

Analisi della scarsa attitudine alla vaccinazione antinfluenzale dei medici italiani del futuro: risultati di uno studio multicentrico condotto in 18 Università Italiane.

Introduzione: Nel corso della stagione influenzale, gli Operatori Sanitari (OS) rappresentano una delle categorie lavorative maggiormente investite dalla responsabilità di limitare la diffusione della patologia influenzale tra i pazienti ospedalizzati e contemporaneamente di proteggere se stessi garantendo la continuità dell'assistenza sanitaria nei periodi di maggiore assenteismo lavorativo e sovraccarico delle attività assistenziali (picco influenzale stagionale). La vaccinazione antinfluenzale, ormai riconosciuta sicura ed efficace, rappresenta ancora oggi una argomento di dibattito tra gli OS, nonostante le raccomandazioni dei Center for Disease Control and Prevention Statunitense ed Europeo a mantenere le coperture tra gli OS sopra il 75%. Numerosi studi confermano come i tassi di vaccinazione antinfluenzale rimangano generalmente bassi sia tra gli OS che in particolare tra i medici in formazione specialistica (MFS). I risultati del presente studio multicentrico cercano di indagare le attitudini e i determinanti associati con la scelta vaccinale antinfluenzale tra i MFS italiani per comprendere le cause e proporre delle soluzioni. Materiali e Metodi: Nel 2012 è stata condotta una survey tra i MFS iscritti a 18 Università Italiane (Bari, Bologna, Brescia, Catania, Catanzaro, Chieti, L'Aquila, Messina, Modena, Napoli Federico II, Palermo, Pavia, Parma, Roma Cattolica, Roma Tor Vergata, Siena, Torino, Verona). Ciascun partecipante è stato contattato tramite una mail in cui erano illustrate le motivazioni dello studio e veniva chiesto di rispondere ad un breve questionario online, anonimo ed autosomministrato che includeva domande sulle attitudini riguardanti la vaccinazione antinfluenzale. Il questionario è stato precedentemente elaborato in collaborazione con il gruppo di lavoro nazionale e successivamente testato in uno studio pilota condotto nell'Università capofila dello studio (Palermo). Results: 2.506 MFS su un totale di 10.854 hanno aderito allo studio (23.1%). L'adesione alla vaccinazione antinfluenzale per la stagione 2011/2012 è stata pari al 11,9%, dato in chiara diminuzione rispetto al 2010/2011 (21.,7%) ed al 2009/2010 (15.5%). I MFS vaccinati nella stagione 2011/2012 sono significativamente più anziani (p=0.006), afferenti all'area clinica (p=0.048), e vaccinati nelle precedenti stagioni influenzali (p<0.001; 2009/2010 e 2010/2011). Inoltre, i MFS che hanno raccomandato la vaccinazione ai propri pazienti sono significativamente più complianti con la vaccinazione nella stagione 2011/2012 (p<0.001). 'Evitare la diffusione dell'influenza tra i pazienti' è la principale motivazione addotta per la vaccinazione (30,5%). Di contro, tra i MFS non vaccinati 'non considerarsi a rischio di contrarre l'influenza' (31,3%) rappresenta la principale causa addotta al rifiuto vaccinale. Secondo i medici in formazione specialistica italiani, l'organizzazione di corsi di formazione multidisciplinare sull'influenza potrebbe rappresentare la migliore strategia per implementare i tassi di immunizzazione tra gli OS. Discussione: I MFS italiani dimostrano una scarsa 'compliance' con la vaccinazione antinfluenzale. Coloro che si vaccinano sembrano accettare la vaccinazione antinfluenzale più come un abitudine, che come una piena responsabilità etica e professionale, mentre coloro che rifiutano la vaccinazione nella stagione precedente usualmente mantengono le proprie convinzioni inalterate nel tempo. La promozione di corrette attitudini e buone pratiche per implementare gli scarsi tassi di adesione alla vaccinazione antinfluenzale tra gli OS potrebbe inoltre rappresentare un passo decisivo anche per migliorare la copertura immunitaria nella popolazione generale

Influenza vaccination coverage among medical residents: An Italian multicenter survey.

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the two previous seasons (P<0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P<0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination. And they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future

Influenza vaccination coverage among medical residents. An Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P < 0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future. © 2014 Landes Bioscience

Influenza vaccination coverage among medical residents: an Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P<0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P<0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future