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Teens are all about the sexting
More teenagers are sending and receiving sexts than in previous years, based on data from a meta-analysis of 39 studies including 110,380 individuals younger than 18 years.
Published rates of sexting in teens range from 1% to 60%, wrote Sheri Madigan, PhD, of the University of Calgary, Alberta, Canada, and her colleagues. “However, the true public health importance of youth sexting is unclear at present because the field is handicapped by inconsistent information regarding its prevalence.”
“Higher prevalence rates were found in more recent studies, with older youth, and with youth using a mobile device to sext,” the researchers said.
The increase in sexting among teens should inform sexting legislation, the researchers noted. However, given the increasing use of smartphones among children and the possibility that sexting may be a normal part of sexual behavior in the smartphone era, “efforts and resources to criminalize sexts should be redirected to educational programs on digital citizenship and healthy relationships,” they said. “Given that the mean age of first smartphone acquisition is 10.3 years, it is important for middle school educators, pediatricians, and parents to have ongoing conversations with tweens regarding sexting and digital citizenship.”
The meta-analysis’s results were limited by several factors, such as the focus on frequency of sexting alone and not on elements that might influence sexting behavior, as well as inclusion of relatively few studies on nonconsensual sexting.
The mean age was 15 years (range, 12-17 years). More than half of the studies were from the United States, followed by 12 from Europe, 2 from Australia, 1 from Canada, 1 from South Africa , and 1 study from South Korea.
The researchers had no relevant financial disclosures. The study was supported by the Alberta Children’s Hospital Foundation and the Canada Research Chairs Program.
SOURCE: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.
“Sexting is a new behavior that is evolving rapidly, as technology changes and awareness increases,” Elizabeth Englander, PhD, and Meghan McCoy, EdD, wrote.
The current study adds to the limited knowledge about sexting in children and teens and also identifies areas in need of additional study, including the lack of a consistent definition of sexting and differences in sexting activity between males and females. Another challenge is determining the context of sexting, with the recognition that sexting within relationships is different than sexting between unattached individuals, they said. In addition, the study by Madigan et al. emphasized the concern for sexting behaviors among children younger than 12 years of age because children this age are increasingly likely to own cell phones.
Dr. Englander and Dr. McCoy concluded that the current study represents “an important step forward in understanding prevalence, including the prevalence of unauthorized distribution of sexts.”
Dr. Englander and Dr. McCoy are affiliated with the Massachusetts Aggression Reduction Center at Bridgewater (Mass.) State University. They commented in an editorial accompanying the meta-analysis by Madigan et al. (JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5682). They had no relevant financial disclosures.
“Sexting is a new behavior that is evolving rapidly, as technology changes and awareness increases,” Elizabeth Englander, PhD, and Meghan McCoy, EdD, wrote.
The current study adds to the limited knowledge about sexting in children and teens and also identifies areas in need of additional study, including the lack of a consistent definition of sexting and differences in sexting activity between males and females. Another challenge is determining the context of sexting, with the recognition that sexting within relationships is different than sexting between unattached individuals, they said. In addition, the study by Madigan et al. emphasized the concern for sexting behaviors among children younger than 12 years of age because children this age are increasingly likely to own cell phones.
Dr. Englander and Dr. McCoy concluded that the current study represents “an important step forward in understanding prevalence, including the prevalence of unauthorized distribution of sexts.”
Dr. Englander and Dr. McCoy are affiliated with the Massachusetts Aggression Reduction Center at Bridgewater (Mass.) State University. They commented in an editorial accompanying the meta-analysis by Madigan et al. (JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5682). They had no relevant financial disclosures.
“Sexting is a new behavior that is evolving rapidly, as technology changes and awareness increases,” Elizabeth Englander, PhD, and Meghan McCoy, EdD, wrote.
The current study adds to the limited knowledge about sexting in children and teens and also identifies areas in need of additional study, including the lack of a consistent definition of sexting and differences in sexting activity between males and females. Another challenge is determining the context of sexting, with the recognition that sexting within relationships is different than sexting between unattached individuals, they said. In addition, the study by Madigan et al. emphasized the concern for sexting behaviors among children younger than 12 years of age because children this age are increasingly likely to own cell phones.
Dr. Englander and Dr. McCoy concluded that the current study represents “an important step forward in understanding prevalence, including the prevalence of unauthorized distribution of sexts.”
Dr. Englander and Dr. McCoy are affiliated with the Massachusetts Aggression Reduction Center at Bridgewater (Mass.) State University. They commented in an editorial accompanying the meta-analysis by Madigan et al. (JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5682). They had no relevant financial disclosures.
More teenagers are sending and receiving sexts than in previous years, based on data from a meta-analysis of 39 studies including 110,380 individuals younger than 18 years.
Published rates of sexting in teens range from 1% to 60%, wrote Sheri Madigan, PhD, of the University of Calgary, Alberta, Canada, and her colleagues. “However, the true public health importance of youth sexting is unclear at present because the field is handicapped by inconsistent information regarding its prevalence.”
“Higher prevalence rates were found in more recent studies, with older youth, and with youth using a mobile device to sext,” the researchers said.
The increase in sexting among teens should inform sexting legislation, the researchers noted. However, given the increasing use of smartphones among children and the possibility that sexting may be a normal part of sexual behavior in the smartphone era, “efforts and resources to criminalize sexts should be redirected to educational programs on digital citizenship and healthy relationships,” they said. “Given that the mean age of first smartphone acquisition is 10.3 years, it is important for middle school educators, pediatricians, and parents to have ongoing conversations with tweens regarding sexting and digital citizenship.”
The meta-analysis’s results were limited by several factors, such as the focus on frequency of sexting alone and not on elements that might influence sexting behavior, as well as inclusion of relatively few studies on nonconsensual sexting.
The mean age was 15 years (range, 12-17 years). More than half of the studies were from the United States, followed by 12 from Europe, 2 from Australia, 1 from Canada, 1 from South Africa , and 1 study from South Korea.
The researchers had no relevant financial disclosures. The study was supported by the Alberta Children’s Hospital Foundation and the Canada Research Chairs Program.
SOURCE: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.
More teenagers are sending and receiving sexts than in previous years, based on data from a meta-analysis of 39 studies including 110,380 individuals younger than 18 years.
Published rates of sexting in teens range from 1% to 60%, wrote Sheri Madigan, PhD, of the University of Calgary, Alberta, Canada, and her colleagues. “However, the true public health importance of youth sexting is unclear at present because the field is handicapped by inconsistent information regarding its prevalence.”
“Higher prevalence rates were found in more recent studies, with older youth, and with youth using a mobile device to sext,” the researchers said.
The increase in sexting among teens should inform sexting legislation, the researchers noted. However, given the increasing use of smartphones among children and the possibility that sexting may be a normal part of sexual behavior in the smartphone era, “efforts and resources to criminalize sexts should be redirected to educational programs on digital citizenship and healthy relationships,” they said. “Given that the mean age of first smartphone acquisition is 10.3 years, it is important for middle school educators, pediatricians, and parents to have ongoing conversations with tweens regarding sexting and digital citizenship.”
The meta-analysis’s results were limited by several factors, such as the focus on frequency of sexting alone and not on elements that might influence sexting behavior, as well as inclusion of relatively few studies on nonconsensual sexting.
The mean age was 15 years (range, 12-17 years). More than half of the studies were from the United States, followed by 12 from Europe, 2 from Australia, 1 from Canada, 1 from South Africa , and 1 study from South Korea.
The researchers had no relevant financial disclosures. The study was supported by the Alberta Children’s Hospital Foundation and the Canada Research Chairs Program.
SOURCE: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.
FROM JAMA PEDIATRICS
Key clinical point: Sexting frequency has increased among teens in recent years, and this frequency increases with age.
Major finding:
Study details: The data come from a meta-analysis of 39 studies with 110,380 participants.
Disclosures: The researchers had no financial conflicts to disclose. The study was supported by the Alberta Children’s Hospital Foundation and the Canada Research Chairs Program.
Source: Madigan S et al. JAMA Pediatr. 2018 Feb 26. doi: 10.1001/jamapediatrics.2017.5314.
Guidelines update best practices for hemorrhoid treatment
Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.
“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.
The guidelines are based on the ASCRS Practice Parameters for the Management of Hemorrhoids published in 2011. The 2018 update was published in the Diseases of the Colon & Rectum.
The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.
“The cardinal signs of internal hemorrhoids are painless bleeding with bowel movements with intermittent protrusion,” the committee said, also emphasizing that patients should be evaluated for fecal incontinence, which could inform surgical decision making.
In addition, the guidelines call for a complete endoscopic evaluation of the colon for patients who present with symptomatic hemorrhoids and rectal bleeding; this recommendation is based on moderately strong evidence, and presented with a grade of 1B.
Medical management of hemorrhoids may include office-based procedures or surgery, according to the guidelines.
“Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation,” the committee wrote, and medical office treatment received a strong grade 1A recommendation based on high-quality evidence. Although office procedures are generally well tolerated, the condition can recur. Bleeding is the most common complication, and it is more likely after rubber-band ligation than other office-based options, the guidelines state.
The guidelines offer a weak recommendation of 2C, based on the lack of quality evidence, for the use of early surgical excision to treat patients with thrombosed external hemorrhoids. “Although most patients treated nonoperatively will experience eventual resolution of their symptoms, excision of thrombosed external hemorrhoids may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals,” the committee noted.
Surgical hemorrhoidectomy received the strongest possible recommendation (1A, based on high-quality evidence) for the treatment of patients with external hemorrhoids or a combination of internal and external hemorrhoids with prolapse.
Surgical options described in the recommendations include surgical excision (hemorrhoidectomy), hemorrhoidopexy, and Doppler-guided hemorrhoidectomy, with citations of studies on each procedure. Data from a meta-analysis of 18 randomized prospective studies comparing hemorrhoidectomy with office-based procedures showed that hemorrhoidectomy was “the most effective treatment for patients with grade III hemorrhoids,” but it was associated with greater pain and complication rates, according to the guidelines.
However, complications in general are low after surgical hemorrhoidectomy, with reported complication rates of 1%-2% for the most common complication of postprocedure hemorrhage, the guidelines state. After surgery, the guidelines recommend with a 1B grade (moderate quality evidence) that patients use “a multimodality pain regimen to reduce narcotic usage and promote a faster recovery.”
The committee members had no financial conflicts to disclose.
AGA offers information for your patients about hemorrhoids at http://www.gastro.org/patient-care/conditions-diseases/hemorrhoids.
SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.
Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.
“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.
The guidelines are based on the ASCRS Practice Parameters for the Management of Hemorrhoids published in 2011. The 2018 update was published in the Diseases of the Colon & Rectum.
The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.
“The cardinal signs of internal hemorrhoids are painless bleeding with bowel movements with intermittent protrusion,” the committee said, also emphasizing that patients should be evaluated for fecal incontinence, which could inform surgical decision making.
In addition, the guidelines call for a complete endoscopic evaluation of the colon for patients who present with symptomatic hemorrhoids and rectal bleeding; this recommendation is based on moderately strong evidence, and presented with a grade of 1B.
Medical management of hemorrhoids may include office-based procedures or surgery, according to the guidelines.
“Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation,” the committee wrote, and medical office treatment received a strong grade 1A recommendation based on high-quality evidence. Although office procedures are generally well tolerated, the condition can recur. Bleeding is the most common complication, and it is more likely after rubber-band ligation than other office-based options, the guidelines state.
The guidelines offer a weak recommendation of 2C, based on the lack of quality evidence, for the use of early surgical excision to treat patients with thrombosed external hemorrhoids. “Although most patients treated nonoperatively will experience eventual resolution of their symptoms, excision of thrombosed external hemorrhoids may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals,” the committee noted.
Surgical hemorrhoidectomy received the strongest possible recommendation (1A, based on high-quality evidence) for the treatment of patients with external hemorrhoids or a combination of internal and external hemorrhoids with prolapse.
Surgical options described in the recommendations include surgical excision (hemorrhoidectomy), hemorrhoidopexy, and Doppler-guided hemorrhoidectomy, with citations of studies on each procedure. Data from a meta-analysis of 18 randomized prospective studies comparing hemorrhoidectomy with office-based procedures showed that hemorrhoidectomy was “the most effective treatment for patients with grade III hemorrhoids,” but it was associated with greater pain and complication rates, according to the guidelines.
However, complications in general are low after surgical hemorrhoidectomy, with reported complication rates of 1%-2% for the most common complication of postprocedure hemorrhage, the guidelines state. After surgery, the guidelines recommend with a 1B grade (moderate quality evidence) that patients use “a multimodality pain regimen to reduce narcotic usage and promote a faster recovery.”
The committee members had no financial conflicts to disclose.
AGA offers information for your patients about hemorrhoids at http://www.gastro.org/patient-care/conditions-diseases/hemorrhoids.
SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.
Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.
“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.
The guidelines are based on the ASCRS Practice Parameters for the Management of Hemorrhoids published in 2011. The 2018 update was published in the Diseases of the Colon & Rectum.
The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.
“The cardinal signs of internal hemorrhoids are painless bleeding with bowel movements with intermittent protrusion,” the committee said, also emphasizing that patients should be evaluated for fecal incontinence, which could inform surgical decision making.
In addition, the guidelines call for a complete endoscopic evaluation of the colon for patients who present with symptomatic hemorrhoids and rectal bleeding; this recommendation is based on moderately strong evidence, and presented with a grade of 1B.
Medical management of hemorrhoids may include office-based procedures or surgery, according to the guidelines.
“Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation,” the committee wrote, and medical office treatment received a strong grade 1A recommendation based on high-quality evidence. Although office procedures are generally well tolerated, the condition can recur. Bleeding is the most common complication, and it is more likely after rubber-band ligation than other office-based options, the guidelines state.
The guidelines offer a weak recommendation of 2C, based on the lack of quality evidence, for the use of early surgical excision to treat patients with thrombosed external hemorrhoids. “Although most patients treated nonoperatively will experience eventual resolution of their symptoms, excision of thrombosed external hemorrhoids may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals,” the committee noted.
Surgical hemorrhoidectomy received the strongest possible recommendation (1A, based on high-quality evidence) for the treatment of patients with external hemorrhoids or a combination of internal and external hemorrhoids with prolapse.
Surgical options described in the recommendations include surgical excision (hemorrhoidectomy), hemorrhoidopexy, and Doppler-guided hemorrhoidectomy, with citations of studies on each procedure. Data from a meta-analysis of 18 randomized prospective studies comparing hemorrhoidectomy with office-based procedures showed that hemorrhoidectomy was “the most effective treatment for patients with grade III hemorrhoids,” but it was associated with greater pain and complication rates, according to the guidelines.
However, complications in general are low after surgical hemorrhoidectomy, with reported complication rates of 1%-2% for the most common complication of postprocedure hemorrhage, the guidelines state. After surgery, the guidelines recommend with a 1B grade (moderate quality evidence) that patients use “a multimodality pain regimen to reduce narcotic usage and promote a faster recovery.”
The committee members had no financial conflicts to disclose.
AGA offers information for your patients about hemorrhoids at http://www.gastro.org/patient-care/conditions-diseases/hemorrhoids.
SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.
FROM DISEASES OF THE COLON & RECTUM
Combo therapy does not improve outcomes for A. Baumannii
, based on data from 406 patients.
In a study published online in The Lancet Infectious Diseases, Mical Paul, MD, of Rambam Health Care Campus, Haifa, Israel, and colleagues randomized 198 patients to colistin alone and 208 to colistin plus meropenem (Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099[18]30099-9).
The demographics were similar between the groups and approximately 77% of patients in each group were infected with A. baumannii.
The results highlight “the necessity of assessing combination therapy in randomized trials before adopting it into clinical use,” the researchers said.
The study was not designed to examine the effect of the two types of therapy on bacteria other than A. baumannii, the researchers noted. However, based on the findings, “we recommend against the routine use of carbapenems for the treatment of carbapenem-resistant A. baumannii infections,” they said.
The study was supported by EU AIDA grant Health-F3-2011-278348. Dr. Paul had no financial conflicts to disclose.
SOURCE: Paul M et al. Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099(18)30099-9.
, based on data from 406 patients.
In a study published online in The Lancet Infectious Diseases, Mical Paul, MD, of Rambam Health Care Campus, Haifa, Israel, and colleagues randomized 198 patients to colistin alone and 208 to colistin plus meropenem (Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099[18]30099-9).
The demographics were similar between the groups and approximately 77% of patients in each group were infected with A. baumannii.
The results highlight “the necessity of assessing combination therapy in randomized trials before adopting it into clinical use,” the researchers said.
The study was not designed to examine the effect of the two types of therapy on bacteria other than A. baumannii, the researchers noted. However, based on the findings, “we recommend against the routine use of carbapenems for the treatment of carbapenem-resistant A. baumannii infections,” they said.
The study was supported by EU AIDA grant Health-F3-2011-278348. Dr. Paul had no financial conflicts to disclose.
SOURCE: Paul M et al. Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099(18)30099-9.
, based on data from 406 patients.
In a study published online in The Lancet Infectious Diseases, Mical Paul, MD, of Rambam Health Care Campus, Haifa, Israel, and colleagues randomized 198 patients to colistin alone and 208 to colistin plus meropenem (Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099[18]30099-9).
The demographics were similar between the groups and approximately 77% of patients in each group were infected with A. baumannii.
The results highlight “the necessity of assessing combination therapy in randomized trials before adopting it into clinical use,” the researchers said.
The study was not designed to examine the effect of the two types of therapy on bacteria other than A. baumannii, the researchers noted. However, based on the findings, “we recommend against the routine use of carbapenems for the treatment of carbapenem-resistant A. baumannii infections,” they said.
The study was supported by EU AIDA grant Health-F3-2011-278348. Dr. Paul had no financial conflicts to disclose.
SOURCE: Paul M et al. Lancet Infect Dis. 2018 Feb 15. doi: 10.1016/S1473-3099(18)30099-9.
FROM THE LANCET INFECTIOUS DISEASES
Guidelines update best practices for hemorrhoid treatment
Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.
“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.
The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.
“The cardinal signs of internal hemorrhoids are painless bleeding with bowel movements with intermittent protrusion,” the committee said, also emphasizing that patients should be evaluated for fecal incontinence, which could inform surgical decision making.
In addition, the guidelines call for a complete endoscopic evaluation of the colon for patients who present with symptomatic hemorrhoids and rectal bleeding; this recommendation is based on moderately strong evidence, and presented with a grade of 1B.
Medical management of hemorrhoids may include office-based procedures or surgery, according to the guidelines.
“Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation,” the committee wrote, and medical office treatment received a strong grade 1A recommendation based on high-quality evidence. Although office procedures are generally well tolerated, the condition can recur. Bleeding is the most common complication, and it is more likely after rubber-band ligation than other office-based options, the guidelines state.
The guidelines offer a weak recommendation of 2C, based on the lack of quality evidence, for the use of early surgical excision to treat patients with thrombosed external hemorrhoids. “Although most patients treated nonoperatively will experience eventual resolution of their symptoms, excision of thrombosed external hemorrhoids may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals,” the committee noted.
Surgical hemorrhoidectomy received the strongest possible recommendation (1A, based on high-quality evidence) for the treatment of patients with external hemorrhoids or a combination of internal and external hemorrhoids with prolapse.
Surgical options described in the recommendations include surgical excision (hemorrhoidectomy), hemorrhoidopexy, and Doppler-guided hemorrhoidectomy, with citations of studies on each procedure. Data from a meta-analysis of 18 randomized prospective studies comparing hemorrhoidectomy with office-based procedures showed that hemorrhoidectomy was “the most effective treatment for patients with grade III hemorrhoids,” but it was associated with greater pain and complication rates, according to the guidelines.
However, complications in general are low after surgical hemorrhoidectomy, with reported complication rates of 1%-2% for the most common complication of postprocedure hemorrhage, the guidelines state. After surgery, the guidelines recommend with a 1B grade (moderate quality evidence) that patients use “a multimodality pain regimen to reduce narcotic usage and promote a faster recovery.”
The committee members had no financial conflicts to disclose.
acssurgerynews@frontlinemedcom.com
SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.
Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.
“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.
The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.
“The cardinal signs of internal hemorrhoids are painless bleeding with bowel movements with intermittent protrusion,” the committee said, also emphasizing that patients should be evaluated for fecal incontinence, which could inform surgical decision making.
In addition, the guidelines call for a complete endoscopic evaluation of the colon for patients who present with symptomatic hemorrhoids and rectal bleeding; this recommendation is based on moderately strong evidence, and presented with a grade of 1B.
Medical management of hemorrhoids may include office-based procedures or surgery, according to the guidelines.
“Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation,” the committee wrote, and medical office treatment received a strong grade 1A recommendation based on high-quality evidence. Although office procedures are generally well tolerated, the condition can recur. Bleeding is the most common complication, and it is more likely after rubber-band ligation than other office-based options, the guidelines state.
The guidelines offer a weak recommendation of 2C, based on the lack of quality evidence, for the use of early surgical excision to treat patients with thrombosed external hemorrhoids. “Although most patients treated nonoperatively will experience eventual resolution of their symptoms, excision of thrombosed external hemorrhoids may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals,” the committee noted.
Surgical hemorrhoidectomy received the strongest possible recommendation (1A, based on high-quality evidence) for the treatment of patients with external hemorrhoids or a combination of internal and external hemorrhoids with prolapse.
Surgical options described in the recommendations include surgical excision (hemorrhoidectomy), hemorrhoidopexy, and Doppler-guided hemorrhoidectomy, with citations of studies on each procedure. Data from a meta-analysis of 18 randomized prospective studies comparing hemorrhoidectomy with office-based procedures showed that hemorrhoidectomy was “the most effective treatment for patients with grade III hemorrhoids,” but it was associated with greater pain and complication rates, according to the guidelines.
However, complications in general are low after surgical hemorrhoidectomy, with reported complication rates of 1%-2% for the most common complication of postprocedure hemorrhage, the guidelines state. After surgery, the guidelines recommend with a 1B grade (moderate quality evidence) that patients use “a multimodality pain regimen to reduce narcotic usage and promote a faster recovery.”
The committee members had no financial conflicts to disclose.
acssurgerynews@frontlinemedcom.com
SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.
Each year, more than 2.2 million patients in the United States undergo evaluations for symptoms of hemorrhoids, according to updated guidelines on the management of hemorrhoids issued by the American Society of Colon and Rectal Surgeons.
“As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the anorectal symptom and to have a clear understanding of the evaluation and management of this disease process,” wrote Bradley R. Davis, MD, FACS, chief of colon and rectal surgery at the Carolinas Medical Center, Charlotte, N.C., and the fellow members of the Clinical Practice Guidelines Committee of the ASCRS.
The guidelines recommend evaluation of hemorrhoids based on a disease-specific history, and a physical that emphasizes the degree and duration of symptoms and identifies risk factors. But the guideline writers note that the recommendation is a grade 1C because the supporting data mainly come from observational or case studies.
“The cardinal signs of internal hemorrhoids are painless bleeding with bowel movements with intermittent protrusion,” the committee said, also emphasizing that patients should be evaluated for fecal incontinence, which could inform surgical decision making.
In addition, the guidelines call for a complete endoscopic evaluation of the colon for patients who present with symptomatic hemorrhoids and rectal bleeding; this recommendation is based on moderately strong evidence, and presented with a grade of 1B.
Medical management of hemorrhoids may include office-based procedures or surgery, according to the guidelines.
“Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation,” the committee wrote, and medical office treatment received a strong grade 1A recommendation based on high-quality evidence. Although office procedures are generally well tolerated, the condition can recur. Bleeding is the most common complication, and it is more likely after rubber-band ligation than other office-based options, the guidelines state.
The guidelines offer a weak recommendation of 2C, based on the lack of quality evidence, for the use of early surgical excision to treat patients with thrombosed external hemorrhoids. “Although most patients treated nonoperatively will experience eventual resolution of their symptoms, excision of thrombosed external hemorrhoids may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals,” the committee noted.
Surgical hemorrhoidectomy received the strongest possible recommendation (1A, based on high-quality evidence) for the treatment of patients with external hemorrhoids or a combination of internal and external hemorrhoids with prolapse.
Surgical options described in the recommendations include surgical excision (hemorrhoidectomy), hemorrhoidopexy, and Doppler-guided hemorrhoidectomy, with citations of studies on each procedure. Data from a meta-analysis of 18 randomized prospective studies comparing hemorrhoidectomy with office-based procedures showed that hemorrhoidectomy was “the most effective treatment for patients with grade III hemorrhoids,” but it was associated with greater pain and complication rates, according to the guidelines.
However, complications in general are low after surgical hemorrhoidectomy, with reported complication rates of 1%-2% for the most common complication of postprocedure hemorrhage, the guidelines state. After surgery, the guidelines recommend with a 1B grade (moderate quality evidence) that patients use “a multimodality pain regimen to reduce narcotic usage and promote a faster recovery.”
The committee members had no financial conflicts to disclose.
acssurgerynews@frontlinemedcom.com
SOURCE: Davis BR et al. Dis Colon Rectum. 2018; 61:284-92.
FROM DISEASES OF THE COLON & RECTUM
Social recovery therapy, early intervention ‘superior’ in first-episode psychosis
Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.
“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.
In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.
The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”
. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.
“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.
The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.
The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.
The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.
SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.
Helping patients with first-episode psychosis improve their social function remains a challenge, Nikolai Albert, MD, and his coauthors wrote in an accompanying editorial. Social recovery therapy could help those patients but must be approached respectfully, they noted.
“The focus on everyday life in social recovery therapy has some promising elements, and seemingly can serve as a supplement to other established forms of individual support,” they wrote.
Social recovery therapy could be a tool to help guide patients with severe social withdrawal back to community living, said Dr. Albert and his coauthors. Despite the small sample size and absence of adequate 15-month follow-up data to show whether the effects of the therapy persist, the findings remain statistically significant and clinically relevant – and offer a promising option for a severely debilitated group of patients, they added (Lancet Psychiatry. 2018 Jan;5[1]:3-4).
Dr. Albert is affiliated with Mental Health Centre Copenhagen at the University of Copenhagen. The authors had no financial conflicts to disclose.
Helping patients with first-episode psychosis improve their social function remains a challenge, Nikolai Albert, MD, and his coauthors wrote in an accompanying editorial. Social recovery therapy could help those patients but must be approached respectfully, they noted.
“The focus on everyday life in social recovery therapy has some promising elements, and seemingly can serve as a supplement to other established forms of individual support,” they wrote.
Social recovery therapy could be a tool to help guide patients with severe social withdrawal back to community living, said Dr. Albert and his coauthors. Despite the small sample size and absence of adequate 15-month follow-up data to show whether the effects of the therapy persist, the findings remain statistically significant and clinically relevant – and offer a promising option for a severely debilitated group of patients, they added (Lancet Psychiatry. 2018 Jan;5[1]:3-4).
Dr. Albert is affiliated with Mental Health Centre Copenhagen at the University of Copenhagen. The authors had no financial conflicts to disclose.
Helping patients with first-episode psychosis improve their social function remains a challenge, Nikolai Albert, MD, and his coauthors wrote in an accompanying editorial. Social recovery therapy could help those patients but must be approached respectfully, they noted.
“The focus on everyday life in social recovery therapy has some promising elements, and seemingly can serve as a supplement to other established forms of individual support,” they wrote.
Social recovery therapy could be a tool to help guide patients with severe social withdrawal back to community living, said Dr. Albert and his coauthors. Despite the small sample size and absence of adequate 15-month follow-up data to show whether the effects of the therapy persist, the findings remain statistically significant and clinically relevant – and offer a promising option for a severely debilitated group of patients, they added (Lancet Psychiatry. 2018 Jan;5[1]:3-4).
Dr. Albert is affiliated with Mental Health Centre Copenhagen at the University of Copenhagen. The authors had no financial conflicts to disclose.
Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.
“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.
In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.
The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”
. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.
“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.
The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.
The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.
The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.
SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.
Adding social recovery therapy to early intervention services significantly improved social function, compared with early intervention alone for young first-episode psychosis patients with extreme social withdrawal, according to data from 155 patients.
“New interventions targeting functional and social recovery are needed in people with first-episode psychosis,” wrote David Fowler of the psychology department at the University of Sussex, Brighton, England, and his colleagues.
In a study known as SUPEREDEN3, published in The Lancet Psychiatry, the researchers randomized 76 patients aged 16-35 years to social recovery therapy plus early intervention and 79 to early intervention alone. The study participants were selected between Oct. 1, 2012, and June 20, 2014, and suffered from extreme social withdrawal as well as complex comorbidities, including anxiety and depression, hopelessness, and residual and treatment-resistant positive psychotic symptoms.
The social recovery therapy, delivered in three stages, included working with the patients to identify new activities and to get them engaged in those pursuits. “Therapists adopt an assertive outreach style of contact, most frequently visiting people at home or in community settings,” the researchers wrote. “Therapists are also encouraged to work systematically with family members, employers, and educational providers to discuss and overcome potential problems that could impede social recovery.”
. Structured activity was defined as time spent over the previous month on activities, including work, education, volunteering, leisure activities, sports, housework or other chores, and child care. No adverse events related to the intervention were reported.
“Our findings show that social recovery therapy plus early intervention services is superior to early intervention services alone on the primary outcome of time spent in structured activity,” Mr. Fowler and his colleagues wrote.
The findings were limited by the lack of data from secondary outcomes, in part because of the challenges of following up with a withdrawn study population, the researchers said. However, they said, the study is the first to show benefits of social recovery therapy in this challenging group.
The results offer “encouragement for practitioners in early intervention services to focus on this subgroup who are often neglected. Our results also suggest that social recovery therapy techniques could be a useful addition in this group,” the researchers said.
The National Institute for Health Research funded the study. The researchers had no financial conflicts to disclose.
SOURCE: Fowler D et al. Lancet Psychiatry. 2018 Jan;5(1):41-50.
FROM THE LANCET PSYCHIATRY
Key clinical point: Adding social recovery therapy significantly improved function in first-episode psychosis patients, compared with early intervention alone.
Major finding: After 9 months, the intervention group averaged 8 more hours of structured activity compared with controls.
Study details: A randomized trial of 155 patients aged 16-35 years.
Disclosures: The National Institute for Health Research funded the study. The investigators had no financial conflicts to disclose.
Source: Fowler D et al. Lancet Psychiatry 2018 Jan;5:41-50.
Lung scan often not requested for new SSc patients
Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.
The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).
In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.
The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.
A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.
The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.
SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.
Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.
The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).
In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.
The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.
A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.
The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.
SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.
Only half of American general rheumatologists and two-thirds of global systemic sclerosis experts routinely request high-resolution CT chest scans for all their newly diagnosed systemic sclerosis patients despite their increased risk of interstitial lung disease, according to survey data from approximately 200 clinicians.
The researchers, led by Elana J. Bernstein, MD, of Columbia University, New York, conducted the survey because of a lack of data on how often rheumatologists order high-resolution CT for their newly diagnosed patients and the absence of clinical practice guidelines that recommend screening for interstitial lung disease (ILD) in systemic sclerosis (SSc).
In a study published in Arthritis & Rheumatology, the researchers surveyed 676 American College of Rheumatology members and 356 global experts on systemic sclerosis; of these, 76 ACR general rheumatologists and 135 SSc experts responded. The use of high-resolution CT varied widely by country or region: 0 of 5 respondents from Australia, 2 of 6 from Canada, 28 of 47 from the United States, 45 of 57 from Europe, 4 of 5 from Asia, and 7 of 7 from Latin America.
The researchers also found little consensus on indications for high-resolution CT in SSc patients. Among the SSc experts who do not routinely obtain screening high-resolution CTs in their SSc patients, 81% said they would request one for dyspnea on exertion, 74% would request one for an abnormal forced vital capacity less than 80% of predicted, and 52% would request one for an abnormal diffusion capacity for carbon monoxide less than 80% predicted.
A significant limitation of the study was the low response rate, and more research is needed on the clinical impact of high-resolution CT screening for ILD in SSc patients, the researchers noted. However, the results highlight the need for a clinical practice guideline to create a more consistent approach to identifying ILD in these patients, they said.
The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.
SOURCE: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.
FROM ARTHRITIS & RHEUMATOLOGY
Key clinical point: Despite the risk of interstitial lung disease in systemic sclerosis patients, the use of high-resolution CT scans of the chest is inconsistent.
Major finding: Overall, 51% of ACR general rheumatologists and 66% of global systemic sclerosis experts ordered high-resolution CTs for new SSc patients.
Study details: The data come from surveys completed by 76 ACR general rheumatologists and 135 SSc experts worldwide.
Disclosures: The researchers had no financial conflicts to disclose. Dr. Bernstein was supported by a Rheumatology Research Foundation Scientist Development Award, and two of her colleagues were funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Heart, Lung, and Blood Institute.
Source: Bernstein E et al. Arthritis Rheumatol. 2018 Feb 9. doi: 10.1002/art.40441.
Major depression identified in almost 21% of U.S. adults
Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).
Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.
In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.
Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).
Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.
The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”
The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.
The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.
SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.
Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).
Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.
In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.
Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).
Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.
The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”
The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.
The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.
SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.
Major depressive disorder (MDD) was identified in 21% of adults in the United States during their lifetimes and 10% over 12 months, according to data published Feb. 14 from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).
Research shows that the prevalence of depression in adolescents and adults in the United States has increased over the last 25 years. However, epidemiologic data on MDD prevalence since the 2013 publication of the DSM-5 have been limited, wrote Deborah S. Hasin, PhD, of Columbia University, New York, and her colleagues.
In a study published in JAMA Psychiatry, Dr. Hasin and her colleagues reviewed data from 36,309 adult participants in the NESARC-III who reflected DSM-5 criteria. Major depressive disorder was defined as at least 2 weeks of persistent depressed mood, anhedonia, or hopelessness reported by the individual or others observing the individual.
Overall, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Factors associated with a more likely 12-month diagnosis of MDD included younger age (18-29 years) and lower income (less than $19,999 per year). In addition, MDD was significantly less likely in men than it was in women (odds ratio, 0.5). Compared with the likelihood among white adults, MDD was less likely among adults who were African American (OR, 0.6), Asian/Pacific Islander (OR, 0.6), and Hispanic (OR, 0.7).
Generalized anxiety disorder was the most common comorbidity associated with MDD (adjusted OR, 5.7). Any drug disorder was three times more likely in MDD patients (aOR, 3.0), and alcohol use disorder was nearly twice as likely (aOR, 1.8). Approximately 70% of patients with lifetime MDD received some treatment. But patients with substance use disorders and depression are less likely to receive treatment for major depression disorder. “Therefore, clinician education and training in dual-disorder screening and treatment should be prioritized,” Dr. Hasin and her colleagues wrote.
The study is the first to include data on two new major depression specifiers from the DSM-5, the researchers noted. “That almost three-quarters of those with MDD had the anxious/distressed specifier confirms clinical observation and research,” they said. “In patient samples, the anxious/distressed specifier predicts a poor course of MDD.”
The study was limited by several factors, including its cross-sectional design and the potentially inconsistent differentiation of MDD from normal bereavement in patients who had been diagnosed with MDD shortly after the death of a loved one, the researchers said. However, the findings provide the first nationally representative information on MDD since the advent of the DSM-5 and highlight the high prevalence of MDD in the U.S. population and the need for further intervention, they said.
The researchers had no financial conflicts to disclose. The NESARC-III was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.
SOURCE: Hasin D et al. JAMA Psychiatry. 2018 Feb 14. doi: 10.1001/jamapsychiatry.2017.4602.
FROM JAMA PSYCHIATRY
Key clinical point: Clinicians should prioritize education and training in treating patients with comorbid MDD and substance use disorders.
Major finding: Among adults in the United States, the 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively.
Data source: The data come from the National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III) for 2012-2013 and includes 36,309 adults.
Disclosures: The researchers had no financial conflicts to disclose. The National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III) was supported by several entities, including the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the New York State Psychiatric Institute.
Source: Hasin D et al. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2017.4602.
USPSTF: Routine screens for ovarian cancer not recommended
does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.
The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.
The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.
The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.
Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.
The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.
The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.
The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.
The task force members had no financial conflicts to disclose.
SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.
Abdominal surgery remains the only way to definitely confirm a positive result for ovarian cancer screening, and therefore any screening protocol must achieve a high level of accuracy to minimize the potential for unnecessary procedures in unaffected women, Charles W. Drescher, MD, and Garnet L. Anderson, PhD, wrote in an accompanying editorial in JAMA Oncology (2018 Feb 13. doi: 10.1001/jamaoncol.2018.0028).
“Screening with cancer antigen 125 (CA-125) and transvaginal sonography (TVS) appears practical, but establishing the value of screening is challenging,” they said. Data from three randomized trials failed to show a disease-specific mortality reduction, and the USPSTF recommendations against routine screening align with recent recommendations from the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and an opinion piece from the Society of Gynecologic Oncology.
Women with germline mutations that increase their risk of ovarian cancer are not included in the recommendations and may be candidates for risk reduction salpingo-oophorectomy (RRSO), which has been shown to reduce ovarian cancer risk but is not confirmed as a preventive measure, the editorialists said.
More targeted screening could improve the likelihood of overall benefit, but the USPSTF recommendations offer “sound clinical and public health recommendations against screening for average-risk, asymptomatic women,” they emphasized. In the meantime, “Potential risks and benefits of screening with CA-125 and TVS deserve to be part of the discussion with high risk women, at least for women not considering RRSO,” they said.
Dr. Drescher and Dr. Anderson are affiliated with the Fred Hutchinson Cancer Center in Seattle. They had no financial conflicts to disclose.
Abdominal surgery remains the only way to definitely confirm a positive result for ovarian cancer screening, and therefore any screening protocol must achieve a high level of accuracy to minimize the potential for unnecessary procedures in unaffected women, Charles W. Drescher, MD, and Garnet L. Anderson, PhD, wrote in an accompanying editorial in JAMA Oncology (2018 Feb 13. doi: 10.1001/jamaoncol.2018.0028).
“Screening with cancer antigen 125 (CA-125) and transvaginal sonography (TVS) appears practical, but establishing the value of screening is challenging,” they said. Data from three randomized trials failed to show a disease-specific mortality reduction, and the USPSTF recommendations against routine screening align with recent recommendations from the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and an opinion piece from the Society of Gynecologic Oncology.
Women with germline mutations that increase their risk of ovarian cancer are not included in the recommendations and may be candidates for risk reduction salpingo-oophorectomy (RRSO), which has been shown to reduce ovarian cancer risk but is not confirmed as a preventive measure, the editorialists said.
More targeted screening could improve the likelihood of overall benefit, but the USPSTF recommendations offer “sound clinical and public health recommendations against screening for average-risk, asymptomatic women,” they emphasized. In the meantime, “Potential risks and benefits of screening with CA-125 and TVS deserve to be part of the discussion with high risk women, at least for women not considering RRSO,” they said.
Dr. Drescher and Dr. Anderson are affiliated with the Fred Hutchinson Cancer Center in Seattle. They had no financial conflicts to disclose.
Abdominal surgery remains the only way to definitely confirm a positive result for ovarian cancer screening, and therefore any screening protocol must achieve a high level of accuracy to minimize the potential for unnecessary procedures in unaffected women, Charles W. Drescher, MD, and Garnet L. Anderson, PhD, wrote in an accompanying editorial in JAMA Oncology (2018 Feb 13. doi: 10.1001/jamaoncol.2018.0028).
“Screening with cancer antigen 125 (CA-125) and transvaginal sonography (TVS) appears practical, but establishing the value of screening is challenging,” they said. Data from three randomized trials failed to show a disease-specific mortality reduction, and the USPSTF recommendations against routine screening align with recent recommendations from the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and an opinion piece from the Society of Gynecologic Oncology.
Women with germline mutations that increase their risk of ovarian cancer are not included in the recommendations and may be candidates for risk reduction salpingo-oophorectomy (RRSO), which has been shown to reduce ovarian cancer risk but is not confirmed as a preventive measure, the editorialists said.
More targeted screening could improve the likelihood of overall benefit, but the USPSTF recommendations offer “sound clinical and public health recommendations against screening for average-risk, asymptomatic women,” they emphasized. In the meantime, “Potential risks and benefits of screening with CA-125 and TVS deserve to be part of the discussion with high risk women, at least for women not considering RRSO,” they said.
Dr. Drescher and Dr. Anderson are affiliated with the Fred Hutchinson Cancer Center in Seattle. They had no financial conflicts to disclose.
does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.
The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.
The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.
The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.
Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.
The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.
The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.
The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.
The task force members had no financial conflicts to disclose.
SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.
does not reduce ovarian cancer mortality and may lead to unnecessary surgery and complications, the U.S. Preventive Services Task Force concluded in a final recommendation statement.
The recommendation statement against screening, along with an evidence report, was published online in JAMA. The USPSTF had issued a recommendation categorized as a D recommendation (“not recommended”) in 2012, and the current review was undertaken to update the evidence on population-based screening.
The task force members based their decision on data from three randomized trials including 293,038 women that assessed ovarian cancer mortality and one trial of 549 women that addressed psychological outcomes.
The screening methods used in the trials included transvaginal ultrasound alone, CA-125 testing alone, and transvaginal ultrasound plus CA-125 testing.
Overall, screening by any of the three methods had no impact on reducing mortality. In addition, surgical complication rates in women without cancer ranged from 3% to 15% across the trials.
The USPSTF found insufficient evidence to comment on potential psychological harms of ovarian cancer screening but said with moderate certainty in the recommendation statement that the harms of routine screening “outweigh the benefit, and the net balance of the benefit and harms of screening is negative,” given the lack of impact on mortality.
The recommendation against screening, however, does not apply to women at increased risk for ovarian cancer because of known genetic mutations, the task force said.
The findings were limited by several factors, including the small percentage of minority women (12%) and lack of generalizability to usual care, the task force members noted. “Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality,” they concluded.
The task force members had no financial conflicts to disclose.
SOURCE: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.
FROM JAMA
Key clinical point: Harms associated with ovarian cancer screening included unnecessary surgery and surgical complications.
Major finding: In three trials including 293,038 women, ovarian cancer screening had no significant impact on mortality.
Study details: The recommendations were based on data from four trials including 293,587 women.
Disclosures: The researchers had no financial conflicts to disclose.
Source: Henderson JT et al. JAMA. 2018;319(6):595-606. doi: 10.1001/jama.2017.21421; Grossman DC et al. JAMA. 2018;319(6):588-594. doi: 10.1001/jama.2017.21926.
Patients want information on religious hospitals’ restrictions
A majority of women want to know about restrictions on care imposed by some religious hospitals, based on data from a survey of 1,430 women.
The survey results, published in the American Journal of Obstetrics and Gynecology, showed that 35% of women thought knowing a hospital’s religion was important when choosing care, but many more – 81% – said that knowing a hospital’s religious restrictions on care was important.
The discrepancy between respondents’ desire to know a hospital’s religious orientation and to know any religious restrictions suggests that many women may have been unaware of restrictions before taking the survey, wrote Lori R. Freedman, PhD, of the University of California, San Francisco, and her colleagues.
Religious hospitals in the United States, 70% of which are Catholic, are a growing part of the health care system, but “no prior studies have asked women from across the United States what information they have and want to have before deciding where to seek care for a miscarriage or other reproductive condition that may be affected by the hospital’s religion,” the researchers said.
The researchers conducted an online survey of women aged 18-45 years who were part of the AmeriSpeak panel, a national database that includes civilian, noninstitutionalized adults. Approximately one-quarter (24%) of the women reported attending a weekly religious service.
Overall, Catholic women were no more likely than non-Catholic women to state that knowing a hospital’s religion or religious-based care restrictions was important. For example, 71% of the participants overall said an acceptable option was to admit a patient, inform her of all treatment options for miscarriage, and refer her elsewhere if she chose an option not available on religious grounds.
“ACOG recommends that institutions make information about all reproductive options available to patients and safeguard patients’ rights to access care consistent with the patient’s own values; however, Catholic hospitals may lack financial, legal, and ideological incentives to voluntarily comply with ACOG’s recommendations,” the researchers noted.
The study findings were limited by several factors, including the use of a panel-based sample and a response rate of approximately 50%. The results, however, suggest that patients need more complete information before choosing a hospital, the researchers said.
The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.
SOURCE: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.
A majority of women want to know about restrictions on care imposed by some religious hospitals, based on data from a survey of 1,430 women.
The survey results, published in the American Journal of Obstetrics and Gynecology, showed that 35% of women thought knowing a hospital’s religion was important when choosing care, but many more – 81% – said that knowing a hospital’s religious restrictions on care was important.
The discrepancy between respondents’ desire to know a hospital’s religious orientation and to know any religious restrictions suggests that many women may have been unaware of restrictions before taking the survey, wrote Lori R. Freedman, PhD, of the University of California, San Francisco, and her colleagues.
Religious hospitals in the United States, 70% of which are Catholic, are a growing part of the health care system, but “no prior studies have asked women from across the United States what information they have and want to have before deciding where to seek care for a miscarriage or other reproductive condition that may be affected by the hospital’s religion,” the researchers said.
The researchers conducted an online survey of women aged 18-45 years who were part of the AmeriSpeak panel, a national database that includes civilian, noninstitutionalized adults. Approximately one-quarter (24%) of the women reported attending a weekly religious service.
Overall, Catholic women were no more likely than non-Catholic women to state that knowing a hospital’s religion or religious-based care restrictions was important. For example, 71% of the participants overall said an acceptable option was to admit a patient, inform her of all treatment options for miscarriage, and refer her elsewhere if she chose an option not available on religious grounds.
“ACOG recommends that institutions make information about all reproductive options available to patients and safeguard patients’ rights to access care consistent with the patient’s own values; however, Catholic hospitals may lack financial, legal, and ideological incentives to voluntarily comply with ACOG’s recommendations,” the researchers noted.
The study findings were limited by several factors, including the use of a panel-based sample and a response rate of approximately 50%. The results, however, suggest that patients need more complete information before choosing a hospital, the researchers said.
The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.
SOURCE: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.
A majority of women want to know about restrictions on care imposed by some religious hospitals, based on data from a survey of 1,430 women.
The survey results, published in the American Journal of Obstetrics and Gynecology, showed that 35% of women thought knowing a hospital’s religion was important when choosing care, but many more – 81% – said that knowing a hospital’s religious restrictions on care was important.
The discrepancy between respondents’ desire to know a hospital’s religious orientation and to know any religious restrictions suggests that many women may have been unaware of restrictions before taking the survey, wrote Lori R. Freedman, PhD, of the University of California, San Francisco, and her colleagues.
Religious hospitals in the United States, 70% of which are Catholic, are a growing part of the health care system, but “no prior studies have asked women from across the United States what information they have and want to have before deciding where to seek care for a miscarriage or other reproductive condition that may be affected by the hospital’s religion,” the researchers said.
The researchers conducted an online survey of women aged 18-45 years who were part of the AmeriSpeak panel, a national database that includes civilian, noninstitutionalized adults. Approximately one-quarter (24%) of the women reported attending a weekly religious service.
Overall, Catholic women were no more likely than non-Catholic women to state that knowing a hospital’s religion or religious-based care restrictions was important. For example, 71% of the participants overall said an acceptable option was to admit a patient, inform her of all treatment options for miscarriage, and refer her elsewhere if she chose an option not available on religious grounds.
“ACOG recommends that institutions make information about all reproductive options available to patients and safeguard patients’ rights to access care consistent with the patient’s own values; however, Catholic hospitals may lack financial, legal, and ideological incentives to voluntarily comply with ACOG’s recommendations,” the researchers noted.
The study findings were limited by several factors, including the use of a panel-based sample and a response rate of approximately 50%. The results, however, suggest that patients need more complete information before choosing a hospital, the researchers said.
The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.
SOURCE: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.
FROM AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY
Key clinical point: Many patients receiving care at religious hospitals are unaware of restrictions on treatment.
Major finding: Approximately 81% of women said it was important to know a hospital’s religious restrictions on care.
Study details: Survey of 1,430 women aged 18-45 years.
Disclosures: The researchers had no financial conflicts to disclose. Dr. Freedman was supported by the Greenwall Foundation. The study was supported by the Society for Family Planning.
Source: Freedman LR et al. Am J Obstet Gynecol. 2018;218:251.e1-9.
Prazosin falls short for veterans’ PTSD-related sleep problems
The alpha-1 adrenergic receptor prazosin failed to improve recurring nightmares or sleep quality compared with placebo in veterans with PTSD in a 26-week randomized trial of 304 adult veterans.
In several previous randomized trials lasting fewer than 15 weeks, veterans with PTSD and recurring nightmares who received prazosin showed benefits, including improved sleep quality and PTSD symptoms, compared with placebo patients, wrote Murray A. Raskind, MD, of the Department of Veterans Affairs Puget Sound Health Care System, Seattle, and his colleagues.
In a study published in the New England Journal of Medicine, the researchers randomized 152 veterans with sleep problems and PTSD to prazosin and 152 to a placebo. The participants were recruited from 12 VA medical centers. The average age of the participants was 52 years, more than 96% were male, and about two-thirds were white. Demographics were similar between the two groups.
After 10 weeks and after 26 weeks, there were no significant differences between the two groups in changes from baseline measures of recurring nightmares, using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). Similarly, no significant differences appeared between the two groups based on Pittsburgh Sleep Quality Index scores.
“A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” reported Dr. Raskind and his colleagues.
The average maintenance dose of prazosin was 14.8 mg, compared with 16.4 mg in the placebo group; 187 male study participants reached the maximum dose of 20 mg/day (54% of the prazosin group and 70% of the placebo group).
After 10 weeks, no significant differences were found between the two groups in changes from baseline measures of “recurring distressing dreams,” using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). The between group difference was 0.2. In addition, no significant differences were found at 10 weeks in the average change from baseline Pittsburgh Sleep Quality Index scores.
Similarly, no significant differences appeared between the two groups at 26 weeks. “ since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” the researchers said.
On average, patients in the prazosin group had significantly greater decreases in blood pressure, compared with the placebo group. In addition, they had fewer reports of new or worsening suicidal ideation, compared with the placebo group (8% vs.15%).
“Given the concern about suicide among veterans, it is noteworthy that the specifically solicited adverse event of new or worsening suicidal ideation was less common in the prazosin group than in the placebo group, but the absolute number of events was small; this issue warrants further study,” the researchers said.
The study was limited by several factors, including the absence of screening for sleep apnea or sleep-disordered breathing, Dr. Raskind and his colleagues noted. However, the results suggest that “further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin.”
Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.
SOURCE: Raskind MA et al. N Engl J Med. 2018 Feb 8;378:507-17. doi: 10.1056/NEJMoa1507598.
The alpha-1 adrenergic receptor prazosin failed to improve recurring nightmares or sleep quality compared with placebo in veterans with PTSD in a 26-week randomized trial of 304 adult veterans.
In several previous randomized trials lasting fewer than 15 weeks, veterans with PTSD and recurring nightmares who received prazosin showed benefits, including improved sleep quality and PTSD symptoms, compared with placebo patients, wrote Murray A. Raskind, MD, of the Department of Veterans Affairs Puget Sound Health Care System, Seattle, and his colleagues.
In a study published in the New England Journal of Medicine, the researchers randomized 152 veterans with sleep problems and PTSD to prazosin and 152 to a placebo. The participants were recruited from 12 VA medical centers. The average age of the participants was 52 years, more than 96% were male, and about two-thirds were white. Demographics were similar between the two groups.
After 10 weeks and after 26 weeks, there were no significant differences between the two groups in changes from baseline measures of recurring nightmares, using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). Similarly, no significant differences appeared between the two groups based on Pittsburgh Sleep Quality Index scores.
“A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” reported Dr. Raskind and his colleagues.
The average maintenance dose of prazosin was 14.8 mg, compared with 16.4 mg in the placebo group; 187 male study participants reached the maximum dose of 20 mg/day (54% of the prazosin group and 70% of the placebo group).
After 10 weeks, no significant differences were found between the two groups in changes from baseline measures of “recurring distressing dreams,” using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). The between group difference was 0.2. In addition, no significant differences were found at 10 weeks in the average change from baseline Pittsburgh Sleep Quality Index scores.
Similarly, no significant differences appeared between the two groups at 26 weeks. “ since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” the researchers said.
On average, patients in the prazosin group had significantly greater decreases in blood pressure, compared with the placebo group. In addition, they had fewer reports of new or worsening suicidal ideation, compared with the placebo group (8% vs.15%).
“Given the concern about suicide among veterans, it is noteworthy that the specifically solicited adverse event of new or worsening suicidal ideation was less common in the prazosin group than in the placebo group, but the absolute number of events was small; this issue warrants further study,” the researchers said.
The study was limited by several factors, including the absence of screening for sleep apnea or sleep-disordered breathing, Dr. Raskind and his colleagues noted. However, the results suggest that “further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin.”
Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.
SOURCE: Raskind MA et al. N Engl J Med. 2018 Feb 8;378:507-17. doi: 10.1056/NEJMoa1507598.
The alpha-1 adrenergic receptor prazosin failed to improve recurring nightmares or sleep quality compared with placebo in veterans with PTSD in a 26-week randomized trial of 304 adult veterans.
In several previous randomized trials lasting fewer than 15 weeks, veterans with PTSD and recurring nightmares who received prazosin showed benefits, including improved sleep quality and PTSD symptoms, compared with placebo patients, wrote Murray A. Raskind, MD, of the Department of Veterans Affairs Puget Sound Health Care System, Seattle, and his colleagues.
In a study published in the New England Journal of Medicine, the researchers randomized 152 veterans with sleep problems and PTSD to prazosin and 152 to a placebo. The participants were recruited from 12 VA medical centers. The average age of the participants was 52 years, more than 96% were male, and about two-thirds were white. Demographics were similar between the two groups.
After 10 weeks and after 26 weeks, there were no significant differences between the two groups in changes from baseline measures of recurring nightmares, using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). Similarly, no significant differences appeared between the two groups based on Pittsburgh Sleep Quality Index scores.
“A possible explanation for these negative results is selection bias resulting from recruitment of patients who were mainly in clinically stable condition, since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” reported Dr. Raskind and his colleagues.
The average maintenance dose of prazosin was 14.8 mg, compared with 16.4 mg in the placebo group; 187 male study participants reached the maximum dose of 20 mg/day (54% of the prazosin group and 70% of the placebo group).
After 10 weeks, no significant differences were found between the two groups in changes from baseline measures of “recurring distressing dreams,” using the mean change from baseline in Clinician-Administered PTSD Score item B2 (recurrent distressing dreams). The between group difference was 0.2. In addition, no significant differences were found at 10 weeks in the average change from baseline Pittsburgh Sleep Quality Index scores.
Similarly, no significant differences appeared between the two groups at 26 weeks. “ since symptoms in such patients were less likely to be ameliorated with antiadrenergic treatment,” the researchers said.
On average, patients in the prazosin group had significantly greater decreases in blood pressure, compared with the placebo group. In addition, they had fewer reports of new or worsening suicidal ideation, compared with the placebo group (8% vs.15%).
“Given the concern about suicide among veterans, it is noteworthy that the specifically solicited adverse event of new or worsening suicidal ideation was less common in the prazosin group than in the placebo group, but the absolute number of events was small; this issue warrants further study,” the researchers said.
The study was limited by several factors, including the absence of screening for sleep apnea or sleep-disordered breathing, Dr. Raskind and his colleagues noted. However, the results suggest that “further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin.”
Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.
SOURCE: Raskind MA et al. N Engl J Med. 2018 Feb 8;378:507-17. doi: 10.1056/NEJMoa1507598.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Prazosin had no apparent effect on recurrent distressing dreams or sleep quality in veterans with PTSD.
Major finding: The between-group difference in scores on a measure of “recurrent distressing dreams” between the prazosin and placebo groups was a nonsignificant 0.2.
Study details: The data come from a randomized trial of 304 military veterans with PTSD who reported frequent nightmares.
Disclosures: Dr. Raskind had no financial conflicts to disclose. The study was supported by the Department of Veterans Affairs Cooperative Studies Program.
Source: Raskind MA et al. N Engl J Med. 2018;378:507-17.