Comparison of pramipexole, fluoxetine, and placebo in patients with major depression

Pramipexole, a dopamine D2 receptor agonist, was tested in 174 patients with major depression, with or without melancholia and without psychotic features. Three daily dose levels (0.375 mg, 1.0 mg, and 5.0 mg) were compared to fluoxetine (Prozac) at 20 mg and placebo in a randomized, double-blind, parallel-group study. After a 1 week placebo run-in period, patients were treated for 8 weeks, had a post-study follow-up (week 9), and were evaluated primarily with the Hamilton Psychiatric Rating Scale for Depression (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinician's Global Impressions-Severity of Illness scale (CGI-SI). All patients who received one dose of study medication were included in the observed-case analysis (no missing data were replaced). Results indicated that by endpoint (week 8), patients receiving pramipexole at the 1.0 mg per day dose had significant improvement over baseline compared to the placebo group by measure of the HAM-D, MADRS, and CGI-SI. Significant improvement in this dose group was seen at other timepoints as well. The most obvious improvement was seen in the pramipexole 5.0 mg group, although a substantial dropout rate for this group precluded statistical tests vs. placebo late in the study. Patients taking fluoxetine also showed significant improvements at endpoint on the MADRS and earlier in the study on the HAM-D. No new or unusual safety concerns were generated during this study. Pramipexole helped safely alleviate the symptoms of depression at 1.0 mg per day and especially in those patients who could tolerate the escalation to 5 mg per day.     

Who is Likely to Successfully Complete a Behavioral Rehabilitation Program?

Abstract

The purpose of this study was to investigate factors identified at intake that may predict whether individuals will successfully complete a six-month, behaviorally-oriented rehabilitation program. Forty-eight persons with severe mental illness were assessed for psychiatric symptomatology, global level of functioning, and performance on social and independent living skills within two weeks of entry into a psychiatric rehabilitation program. Successful program completion was operationalized as attendance at the program for six months or more without psychiatric rehospitalization and linkage with a more advanced treatment program. Results suggest that participants with better social and independent living skills were more likely to successfully complete the program; psychiatric symptoms were not related to treatment success. These findings have implications for targeting psychiatric rehabilitation programs.     

The Coagulation Mechanism in Acute Bacterial Infection

Successive coagulation studies were performed in 34 adult patients hospitalized for treatment of acute bacterial infection. Increased fibrinogen, factor-VIII activity, and platelets were found in more than 50% of the patients studied. Classical disseminated intravascular coagulation occurred in three cases. Nine patients had elevated fibrin split products in various combinations with transient hypofibrinogenaemia, thrombocytopenia, and reduced factor-V activity. The appearance of elevated fibrin split products together with transient hypofibrinogenaemia, thrombocytopenia, and reduced factor-V activity in some patients may reflect the presence of subclinical disseminated intravascular coagulation.     

Feasibility and Preliminary Validation of an Online Version of the Ohio State University Traumatic Brain Injury Identification Method

Objective

To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).

Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine

In response to public pressure for greater accountability from the medical profession, a transformation is occurring in the approach to medical education and assessment of physician competency. Over the past 5 years, the Accreditation Council for Graduate Medical Education (ACGME) has implemented the Outcomes and General Competencies projects to better ensure that physicians are appropriately trained in the knowledge and skills of their specialties. Concurrently, the American Board of Medical Specialties, including the American Board of Emergency Medicine (ABEM), has embraced the competency concept. The core competencies have been integral in ABEM's development of Emergency Medicine Continuous Certification and the development of the Model of Clinical Practice of Emergency Medicine (Model).¹ ABEM has used the Model as a significant part of its blueprint for the written and oral certification examinations in emergency medicine and is fully supportive of the effort to more fully define and integrate the ACGME core competencies into training emergency medicine specialists.To incorporate these competencies into our specialty, an Emergency Medicine Competency Taskforce (Taskforce) was formed by the Residency Review Committee–Emergency Medicine to determine how these general competencies fit in the Model.¹ This article represents a consensus of the Taskforce with the input of multiple organizations in emergency medicine. It provides a framework for organizations such as the Council of Emergency Medicine Residency Directors (CORD) and the Society for Academic Emergency Medicine to develop a curriculum in emergency medicine and program requirement revisions by the Residency Review Committee–Emergency Medicine. In this report, we describe the approach taken by the Taskforce to integrate the ACGME core competencies into the Model. Ultimately, as competency-based assessment is implemented in emergency medicine training, program directors, governing bodies such as the ACGME, and individual patients can be assured that physicians are competent in emergency medicine.