In resource-rich countries, 5-year survival rates for children with cancer approach 85%. This imp... more In resource-rich countries, 5-year survival rates for children with cancer approach 85%. This impressive statistic is largely the result of integrating research with clinical care. At the core of this endeavor are multiagent combination chemotherapy and supportive care agents (CASCA). Most CASCAs belong to the class of sterile injectable drugs, which make up the backbone of many proven and life-saving pediatric oncology regimens. There are few if any alternative agents available to treat most life-threatening childhood cancers. In the United States, shortages of CASCAs are now commonplace. The consequences of drug shortages are far reaching. Beyond the economic costs, these shortages directly affect patients’ lives, and this is especially true for children with cancer. Drug shortages in general and shortages of CASCAs specifically result in increased medication errors, delayed administration of life-saving therapy, inferior outcomes, and patient deaths. One way to mitigate drug shortages is to adopt an essential medicines list and ensure that these medications remain in adequate supply at all times. We argue for creation of a CASCA-specific essential medicines list for childhood cancer and provide ethical and policy-based reasoning for this approach. We recognize that such a call has implications beyond pediatric cancer, in that children with other serious disease should have an equal claim to access to guaranteed evidence-based medicines. We provide these arguments as an example of what should be claimed for medical indications that are deemed essential to preserve life and function.
... D., Linda S. Higgins, Ph. D., Jeffrey Higaki, Ph. D., Ziyang Zhong, Ph. D., Paula M.Moran, Ph... more ... D., Linda S. Higgins, Ph. D., Jeffrey Higaki, Ph. D., Ziyang Zhong, Ph. D., Paula M.Moran, Ph. D., and Paul C. Moser, Ph. D ... Ph. D., Emma Shulman, MS, Gertrude Steinberg, MA, Abby Ambinder, Ed. D., and Joan Mackell, Ph. ...
Urinary levels of the serotonin metabolite S-hydroxyindoleacetic acid (SHIAA) and the norepinephr... more Urinary levels of the serotonin metabolite S-hydroxyindoleacetic acid (SHIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 45 patients with generalized anxiety disorder. Multiple regression analysis demonstrated that the severity of several anxiety symptoms was predicted by levels of S-HIAA and VMA. These data are consistent with the proposal that serotonin and norepinephrine may be involved in the pathophysiology of anxiety.
Page 1. al Health Practice in Geriatric Health Care Settings r Page 2. Page 3. Peter A. Lichtenbe... more Page 1. al Health Practice in Geriatric Health Care Settings r Page 2. Page 3. Peter A. Lichtenberg, PhD, ABPP Mental Health Practice in Geriatric Health Care Settings Pre-publication REVIEWS, COMMENTARIES, EVALUATIONS. . . ...
Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in... more Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in a double-blind manner for 8 weeks, were analyzed to identify demographic and clinical characteristics of the patients that might predict response to treatment. The strongest predictors of response to alprazolam were age over 40, and lower baseline levels of anxiety and phobic symptoms. Predictors of response to placebo were weaker and, in addition to lower levels anxiety and panic attacks, included a lack of previous psychiatric treatment.
The Psychiatry Resident In-Training Examination (PRITE) is given annually in a majority of accred... more The Psychiatry Resident In-Training Examination (PRITE) is given annually in a majority of accredited psychiatry residency training programs. The reliability and validity of the examination has been established. This study compared faculty evaluations of resident performance and professional knowledge with the performance on the PRITE for 7 consecutive years (1990–1996). The resident scores on the PRITE correlated well with the faculty evaluations the same year. This study reinforces the concurrent criterion validity of the PRITE and its value as an additional assessment of resident performance.
Shortages of life-saving chemotherapy and supportive care agents for children with cancer are fre... more Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework p...
A survey of all hospital pharmacies in the former North Western Regional Health Authority has rev... more A survey of all hospital pharmacies in the former North Western Regional Health Authority has revealed that hospital personnel continue to prepare cytotoxic drugs in suboptimal conditions, despite the widespread introduction of pharmacy cytotoxic reconstitution services. Other concerns include the lack of formal training for medical staff in the administration of these agents and the frequent absence of written procedures for dealing with extravasation and chemotherapy errors.
The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this st... more The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had a pretransplantation diagnosis of an anxiety and/or depressive disorders. Of the 30 patients transplanted, 19 survived 12 months or more, and 11 died less than 12 months posttransplantation. The Ͼ12month survival group had a mean age of 45.2 years at transplantation, compared with a mean age of 43.0 years in the Ͻ12-month group (NS). The mean Psychosocial Assessment of Candidates for Transplant score and premorbid history of smoking did not differ between the groups. The Ͼ12-month survival group had more psychiatric illness pretransplantation than the Ͻ12month survival group (56% vs. 27%, PϽ0.05). The recipients with a psychiatric history (Nס 15) were more likely to survive 1 year posttransplantation than the recipients without a psychiatric history (80% vs. 47%, PϽ0.05) and were not significantly different from the recipients without a psychiatric history in terms of episodes of rejection, bronchiolitis obliterans, or noncompliance with treatment. Depression and anxiety are treatable disorders that occur frequently in patients with end-stage lung disease, and a premorbid history of either did not predict a worse outcome posttransplantation in this study of lung transplantation recipients.
Twenty-one medication-free patients with generalized anxiety disorder (GAD) collected urine sampl... more Twenty-one medication-free patients with generalized anxiety disorder (GAD) collected urine samples for 5-hydroxyindoleacetic acid (5-HIAA) and N-acetyl-beta-glucosaminidase (NAG). Nine patients with no comorbid psychiatric diagnosis showed a significant association between 5-HIAA and NAG, r = -0.683, p = 0.04. The possibility that NAG could be a marker for serotonin metabolism is discussed.
Examination of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), in the urine of psy... more Examination of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), in the urine of psychiatry patients has generally not been used because the reliability of urinary 5-HIAA levels has been questioned. Thirty-seven generalized anxiety disordered patients collected two consecutive urines for measurement of 5-HIAA. The correlation of the 5-HIAA collections was r = 0.82, p = 0.0001.
There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiolo... more There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiology of anxiety disorders. Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 46 patients with generalized anxiety disorder. There was a significant association between urinary levels of 5-HIAA and VMA: r = 0.79; p = 0.0001. Possible implications of this finding are discussed.
Childhood cancer survivors are at risk for development of subsequent neoplasms of the central ner... more Childhood cancer survivors are at risk for development of subsequent neoplasms of the central nervous system (CNS). Better understanding of the rates, risk factors for and outcomes of subsequent neoplasms of the CNS among survivors of childhood cancer may lead to the development of more informed screening guidelines. Two independent investigators independently performed a systematic search of studies from the MEDLINE and EMBASE databases (1966-2012) for studies examining subsequent neoplasms of the CNS among childhood cancer survivors. Articles were selected to answer 3 questions: What is the risk of CNS
In resource-rich countries, 5-year survival rates for children with cancer approach 85%. This imp... more In resource-rich countries, 5-year survival rates for children with cancer approach 85%. This impressive statistic is largely the result of integrating research with clinical care. At the core of this endeavor are multiagent combination chemotherapy and supportive care agents (CASCA). Most CASCAs belong to the class of sterile injectable drugs, which make up the backbone of many proven and life-saving pediatric oncology regimens. There are few if any alternative agents available to treat most life-threatening childhood cancers. In the United States, shortages of CASCAs are now commonplace. The consequences of drug shortages are far reaching. Beyond the economic costs, these shortages directly affect patients’ lives, and this is especially true for children with cancer. Drug shortages in general and shortages of CASCAs specifically result in increased medication errors, delayed administration of life-saving therapy, inferior outcomes, and patient deaths. One way to mitigate drug shortages is to adopt an essential medicines list and ensure that these medications remain in adequate supply at all times. We argue for creation of a CASCA-specific essential medicines list for childhood cancer and provide ethical and policy-based reasoning for this approach. We recognize that such a call has implications beyond pediatric cancer, in that children with other serious disease should have an equal claim to access to guaranteed evidence-based medicines. We provide these arguments as an example of what should be claimed for medical indications that are deemed essential to preserve life and function.
... D., Linda S. Higgins, Ph. D., Jeffrey Higaki, Ph. D., Ziyang Zhong, Ph. D., Paula M.Moran, Ph... more ... D., Linda S. Higgins, Ph. D., Jeffrey Higaki, Ph. D., Ziyang Zhong, Ph. D., Paula M.Moran, Ph. D., and Paul C. Moser, Ph. D ... Ph. D., Emma Shulman, MS, Gertrude Steinberg, MA, Abby Ambinder, Ed. D., and Joan Mackell, Ph. ...
Urinary levels of the serotonin metabolite S-hydroxyindoleacetic acid (SHIAA) and the norepinephr... more Urinary levels of the serotonin metabolite S-hydroxyindoleacetic acid (SHIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 45 patients with generalized anxiety disorder. Multiple regression analysis demonstrated that the severity of several anxiety symptoms was predicted by levels of S-HIAA and VMA. These data are consistent with the proposal that serotonin and norepinephrine may be involved in the pathophysiology of anxiety.
Page 1. al Health Practice in Geriatric Health Care Settings r Page 2. Page 3. Peter A. Lichtenbe... more Page 1. al Health Practice in Geriatric Health Care Settings r Page 2. Page 3. Peter A. Lichtenberg, PhD, ABPP Mental Health Practice in Geriatric Health Care Settings Pre-publication REVIEWS, COMMENTARIES, EVALUATIONS. . . ...
Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in... more Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in a double-blind manner for 8 weeks, were analyzed to identify demographic and clinical characteristics of the patients that might predict response to treatment. The strongest predictors of response to alprazolam were age over 40, and lower baseline levels of anxiety and phobic symptoms. Predictors of response to placebo were weaker and, in addition to lower levels anxiety and panic attacks, included a lack of previous psychiatric treatment.
The Psychiatry Resident In-Training Examination (PRITE) is given annually in a majority of accred... more The Psychiatry Resident In-Training Examination (PRITE) is given annually in a majority of accredited psychiatry residency training programs. The reliability and validity of the examination has been established. This study compared faculty evaluations of resident performance and professional knowledge with the performance on the PRITE for 7 consecutive years (1990–1996). The resident scores on the PRITE correlated well with the faculty evaluations the same year. This study reinforces the concurrent criterion validity of the PRITE and its value as an additional assessment of resident performance.
Shortages of life-saving chemotherapy and supportive care agents for children with cancer are fre... more Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework p...
A survey of all hospital pharmacies in the former North Western Regional Health Authority has rev... more A survey of all hospital pharmacies in the former North Western Regional Health Authority has revealed that hospital personnel continue to prepare cytotoxic drugs in suboptimal conditions, despite the widespread introduction of pharmacy cytotoxic reconstitution services. Other concerns include the lack of formal training for medical staff in the administration of these agents and the frequent absence of written procedures for dealing with extravasation and chemotherapy errors.
The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this st... more The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had a pretransplantation diagnosis of an anxiety and/or depressive disorders. Of the 30 patients transplanted, 19 survived 12 months or more, and 11 died less than 12 months posttransplantation. The Ͼ12month survival group had a mean age of 45.2 years at transplantation, compared with a mean age of 43.0 years in the Ͻ12-month group (NS). The mean Psychosocial Assessment of Candidates for Transplant score and premorbid history of smoking did not differ between the groups. The Ͼ12-month survival group had more psychiatric illness pretransplantation than the Ͻ12month survival group (56% vs. 27%, PϽ0.05). The recipients with a psychiatric history (Nס 15) were more likely to survive 1 year posttransplantation than the recipients without a psychiatric history (80% vs. 47%, PϽ0.05) and were not significantly different from the recipients without a psychiatric history in terms of episodes of rejection, bronchiolitis obliterans, or noncompliance with treatment. Depression and anxiety are treatable disorders that occur frequently in patients with end-stage lung disease, and a premorbid history of either did not predict a worse outcome posttransplantation in this study of lung transplantation recipients.
Twenty-one medication-free patients with generalized anxiety disorder (GAD) collected urine sampl... more Twenty-one medication-free patients with generalized anxiety disorder (GAD) collected urine samples for 5-hydroxyindoleacetic acid (5-HIAA) and N-acetyl-beta-glucosaminidase (NAG). Nine patients with no comorbid psychiatric diagnosis showed a significant association between 5-HIAA and NAG, r = -0.683, p = 0.04. The possibility that NAG could be a marker for serotonin metabolism is discussed.
Examination of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), in the urine of psy... more Examination of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), in the urine of psychiatry patients has generally not been used because the reliability of urinary 5-HIAA levels has been questioned. Thirty-seven generalized anxiety disordered patients collected two consecutive urines for measurement of 5-HIAA. The correlation of the 5-HIAA collections was r = 0.82, p = 0.0001.
There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiolo... more There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiology of anxiety disorders. Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 46 patients with generalized anxiety disorder. There was a significant association between urinary levels of 5-HIAA and VMA: r = 0.79; p = 0.0001. Possible implications of this finding are discussed.
Childhood cancer survivors are at risk for development of subsequent neoplasms of the central ner... more Childhood cancer survivors are at risk for development of subsequent neoplasms of the central nervous system (CNS). Better understanding of the rates, risk factors for and outcomes of subsequent neoplasms of the CNS among survivors of childhood cancer may lead to the development of more informed screening guidelines. Two independent investigators independently performed a systematic search of studies from the MEDLINE and EMBASE databases (1966-2012) for studies examining subsequent neoplasms of the CNS among childhood cancer survivors. Articles were selected to answer 3 questions: What is the risk of CNS
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