Can an Accelerated Gambling Simulation Reduce Persistence on a Gambling Task?

We evaluated an intervention based on a digital slot machine accelerator and whether the accelerator would decrease persistence in play on a subsequent gambling analog task. Ninety college students were randomly assigned to one of three interventions: the digital slot machine accelerator; an educational handout describing probabilities and concepts related to slot machine gambling; a control handout unrelated to gambling. Participants then played a realistic three-reel 5¢ slot machine pre-loaded with 30 credits. Participants could stop playing on any trial and could keep winnings beyond the initial 30 credits. We found that exposure to either the accelerator or educational handout decreased participants’ judgments of the probability of winning. However, only participants in the accelerator condition, not those in the educational handout condition, played significantly fewer trials on the slot machine than controls. Thus, intervention and prevention efforts may be strengthened by advanced gambling simulation that experientially demonstrate the negative long-term outcomes of gambling.     

Frequent off-label use of fondaparinux in patients with suspected acute heparin-induced thrombocytopenia (HIT) – findings from the GerHIT multi-centre registry study

Introduction

In life-threatening immune heparin-induced thrombocytopenia (HIT), treatment with an approved non-heparin anticoagulant is essential. However, off-label use with fondaparinux has been reported in the literature. The study aim was to collect data on “real-life” management of patients with suspected acute HIT regarding diagnostic and therapeutic strategies.

Patients and Methods

In a national multi-centre registry study, patients with a 4 T’s HIT-probability score of ≥ 4 points and treatment with at least one dose of (A)rgatroban, (L)epirudin, (D)anaparoid, or (F)ondaparinux were retrospectively evaluated.

Results

Of 195 patients, the 4 T’s scores were 4/5/6/7/8 points in 46 (23.6%)/50 (25.6%)/74 (38.0%)/13 (6.7%)/7 (3.6%) patients, respectively. During heparin therapy, 47 (24.1%) thromboembolic events, 5 (2.6%) skin lesions, 1 (0.5%) amputation, 24 (12.3%) Hb-relevant bleedings, and 2 (1.0%) fatalities occurred. A functional heparin-induced platelet activation assay was performed in 96.9%, a platelet factor 4/heparin-dependent enzyme immunoassay in 89.2%, a particle gel immunoassay in 12.3%, and a serotonin-release assay in none of the patients. Argatroban was used in 16.4%, lepirudin in 2.1%, danaparoid in 23.6%, fondaparinux in 40.0% of the patients; the sequential therapy strata were: AF (5.6%), DA (5.6%), DF (2.6%), DL (2.1%), ADF (1.5%), and DFL (0.5%).

Conclusions

The current diagnostic laboratory strategy for suspected HIT is mostly (> 96%) based on the recommended 2-step strategy (immunoassay plus functional assay). However, there is a wide fondaparinux off-label use (up to 50.3%) for suspected HIT, even in those patients with a high clinical pretest probability. Efficacy and safety of fondaparinux for HIT-treatment require further evaluation.     

Therapie der venösen Thromboembolie

The main objectives in the treatment of venous thromboembolism are to prevent clot extension and pulmonary embolism, to reduce mortality and to prevent recurrent thromboembolic events as well as postthrombotic disorders. Initial and effective anticoagulation with heparin, preferably with low molecular weight heparin (LMWH), or with fondaparinux is the most important measure. Unfractioned heparin (UFH) is as effective as LMWH, but requires coagulation-monitoring and is associated with a higher risk of heparin-induced thrombocytopenia. In patients with renal insufficiency direct determination of anti-factor Xa activity and dose adjustment is recommended, since drug accumulation can occur over time. In those patients UFH instead of LMWH might be favored. Long-term treatment should be administered with vitamin K-antagonists (INR-target range 2–3) for a duration of 3 to 6 months. In case of recurrent venous thromboembolism, indefinite therapy is recommended. Additional treatment with compression stockings is reasonable. Patients who do not require hospital treatment for other conditions, who have a low bleeding risk, no excessive venous congestion and no symptomatic pulmonary embolism can safely be treated at home. In most cases bed rest is not necessary. Thrombolysis or surgical thrombectomy is seldomly indicated in severe thromboembolism.     

Determination of heparin–platelet factor 4–IgG antibodies improves diagnosis of heparin-induced thrombocytopenia

Only a few patients with heparin-induced antibodies develop heparin-induced thrombocytopenia (HIT). In this study, we investigated whether different immunglobulin classes can be used to differentiate between antibody-positive patients with and without HIT. Four different patient populations were investigated: 32 patients with the immune type of HIT with thromboembolic complications, 13 patients with HIT without thromboembolism, 24 patients with heparin-platelet factor 4 (PF4) antibodies without clinical symptoms of HIT, and 20 heparin-treated patients with thrombocytopenia caused by other reasons. In all patients the immunglobulin mixture of IgG, IgM and IgA, and the single immunglobulin classes of heparin-PF4 antibodies, were investigated. No significant differences between HIT patients with thromboembolic complications and patients with isolated HIT were found concerning the different immunglobulin classes. Antibody-positive patients with HIT had significantly higher levels of IgG antibodies than those without HIT (P < 0.05), while they did not differ concerning IgM and IgA antibodies. By determining IgG antibodies, the specificity of the enzyme-linked immunosorbent assay (ELISA) system was increased without loss of sensitivity. Heparin-PF4-IgG antibodies can identify patients at risk of developing life-threatening HIT. Future ELISAs should only include this immunglobulin class, as the determination of the antibody mixture may lead to overestimation of HIT.     

Influence of blood collection techniques on platelet function

For investigations of platelet function it is recommended that venipuncture should be performed using ordinary needle systems instead of butterfly cannulae systems. Platelets might be activated in the long plastic tubes of butterfly systems. The aim of this study was to investigate the dependency of platelet function results on blood sampling using different collection systems. Therefore, blood of 25 healthy volunteers was collected from both arms using at the same time on one side a 21-gauge needle and on the other side a 21-gauge butterfly cannula system. Both samples of each volunteer were analyzed on the PFA-100. Platelet aggregation was performed on the Behring Coagulation Timer (BCT) and the optical aggregometer PAP-4 using ADP, collagen and arachidonic acid to induce platelet aggregation in platelet-rich plasma. No significant prolongation of the closure times on the PFA-100 with the COL/EPI cartridge and the COL/ADP cartridge was observed when using butterfly cannulae. The results of optical aggregometry were not significantly different. The maximum aggregation response did not differ significantly for both collection systems. Aggregometry and the PFA-100 system are not affected by different blood collection systems. Therefore butterfly cannulae can be used for sample collection to investigate platelet function.     

Phosphatidylserine IgG and beta-2-glycoprotein I IgA antibodies may be a risk factor for ischaemic stroke

OBJECTIVE: Antiphospholipid antibodies (APLA) are established risk factors for venous thrombosis but their role in the pathogenesis of cerebral ischaemia is unclear. The purpose of the present study was to evaluate the relevance of various APLA in patients with cryptogenic stroke (group A, n = 21) and determined causes of stroke (group B, n = 104) according to the TOAST classification in comparison with healthy volunteers without any thrombotic or ischaemic event in their history (group C, n = 84). METHODS: Median ages were 52 yr (A), 60 yr (B) and 51 yr (C). Blood samples were tested for lupus anticoagulant (LA) using phospholipid-dependent coagulation tests (activated partial thromboplastin time, diluted Russell viper venom time). Confirmatory tests were performed if necessary. Furthermore, we assessed the presence of specific APLA and their antibody subclasses against cardiolipin (AclA), phosphatidylserine (ApsA), phosphatidylinositol (ApiA) and beta-2-glycoprotein I (Abeta2A) using enzyme-linked immunosorbent assay. RESULTS: For ApsA IgG we found a significantly higher prevalence in stroke patients (57.7%) compared with normal subjects (4.8%; P < 0.001). Similarly, Abeta2A IgA was significantly more prevalent in stroke patients (20.8%) in comparison with normals (3.6%; P < 0.001). For all other APLAs tested, no significant differences emerged after adjustment for multiple comparisons. We did not find significant differences between stroke subtypes for any APLA. CONCLUSION: The results of this study suggest a relevant role for antiphosphatidylserine IgG and anti-beta2-glycoprotein I IgA in stroke aetiology.     

The Use of Messages in Altering Risky Gambling Behavior in College Students: An Experimental Analogue Study

This study examined the effects of messages on altering risky gambling behavior in college students. While playing a chance‐based computerized game with play money, three groups of participants either viewed occasional accurate messages that correctly described the contingencies of the game, neutral messages unrelated to the contingencies, or no messages. Participants in the accurate message condition spent overall less money gambling, played fewer trials in the final phase of the game when all trials resulted in losses, and were more likely to quit the game while they still had money remaining in the bank. The findings suggest that “reminders” about the random nature of games and the overall negative rate of return might lead to more responsible gaming.     

Impact of falls on depressive symptoms among the oldest old: Results from the AgeQualiDe study

Objective

The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally.

Methods

Data were used from 2 waves of the multicenter prospective cohort “Study on needs, health service use, costs and health‐related quality of life in a large sample of oldest‐old primary care patients (85+)” (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88.9 ± 3.0 years; ranging from 85 to 100 years). General practitioner‐diagnosed falls were used as explanatory variable. The Geriatric Depression Scale was used as outcome measure.

Results

Linear fixed effects regressions showed that the occurrence of falls is associated with an increase in depressive symptoms (β = .60, P = .02), whereas changes in marital status, ageing, social support, functional decline (instrumental activity of daily living), cognitive impairment, and an increase in chronic diseases did not affect depressive symptoms. In sensitivity analysis, an increase in depressive symptoms was associated with functional impairment (basic activities of daily living; Barthel index; β = ?.04, P = .005).

Conclusions

Based on a large, population‐based longitudinal study, this study underlined the impact of falls on depressive symptoms and consequently extended previous knowledge about an association between falls and depressive symptoms in the oldest old. Developing strategies to prevent falls might also help to prevent depressive symptoms.