Publications by authors named "Clare Lambert"

11 Publications

  • Page 1 of 1

Second-Generation Antipsychotic Use in Pediatric Emergency Medicine.

Pediatr Emerg Care 2021 Mar;37(3):161-164

Professor, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, University of British Columbia; BC Children's Hospital Research Institute, Vancouver, BC, Canada.

Abstract: In recent years, the number of patients presenting to the emergency department with mental health complaints has been growing, alongside an increase in second-generation antipsychotic (SGAs) prescriptions for a variety of mental health conditions. Children treated with SGAs may have abnormalities, such as rapid weight gain and central adiposity, glucose intolerance, dyslipidemia, and hypertension; they may present to the pediatric emergency department with components of metabolic syndrome or type 2 diabetes, and a subsequent significant risk for cardiovascular complications later in life. Pediatric emergency department providers may serve as a safety net for patients to detect SGA-related metabolic complications, especially among vulnerable populations lacking access to primary care or psychiatric services.
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http://dx.doi.org/10.1097/PEC.0000000000002387DOI Listing
March 2021

Trends in ischemic stroke outcomes in a rural population in the United States.

J Neurol Sci 2021 Mar 9;422:117339. Epub 2021 Feb 9.

Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, United States. Electronic address:

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018.

Methods: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called "Geisinger NeuroScience Ischemic Stroke (GNSIS)" was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data.

Results: The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ± 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age > 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence.

Conclusion: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.
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http://dx.doi.org/10.1016/j.jns.2021.117339DOI Listing
March 2021

Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States.

Ther Adv Neurol Disord 2020 18;13:1756286420971895. Epub 2020 Dec 18.

Geisinger NeuroScience Institute, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822, USA.

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States.

Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan-Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine-Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors.

Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1-81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome.

Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.
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http://dx.doi.org/10.1177/1756286420971895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750897PMC
December 2020

Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States.

Ther Adv Neurol Disord 2020 18;13:1756286420971895. Epub 2020 Dec 18.

Geisinger NeuroScience Institute, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822, USA.

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States.

Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan-Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine-Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors.

Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1-81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome.

Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.
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http://dx.doi.org/10.1177/1756286420971895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750897PMC
December 2020

Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With CNS Tumors.

J Pediatr Hematol Oncol 2020 Nov 23. Epub 2020 Nov 23.

Pediatrics, Division of Hematology/Oncology/BMT, University of British Columbia, BC Children's Research Institute, Vancouver, BC, Canada.

Central nervous system (CNS) tumors in children are a devastating diagnosis and delay in diagnosis is well documented in the literature. The aim of this study was to document and characterize time to diagnosis of CNS tumors among children 0 to 17 years of age in a pediatric center. A retrospective chart review was conducted of medical records of children with CNS tumors from 2000 to 2016 in British Columbia, Canada and 148 reports were available for review. Average age at diagnosis was 87.8 months (SD=59.7; median=72). One third (30%) were diagnosed after a single visit to a health care provider and 11 (7.7%) after more than 4 visits. Median time to diagnosis (prediagnostic symptomatic interval [PSI]) was 62 days (average 197±341 d; range, 0 to 2047 d). Longest period was time from first symptom to first health care provider visit (PSI1, median 37 d). Tumors in the posterior fossa and symptoms of ataxia or paresis were associated with a significantly shorter PSI. CNS tumors in children continue to pose a diagnostic challenge with variability in time to diagnosis. Our population-based study suggests variability in time to diagnosis with a need for education of families to identify symptoms associated with CNS tumors.
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http://dx.doi.org/10.1097/MPH.0000000000002012DOI Listing
November 2020

Pain management for children needing laceration repair.

Can Fam Physician 2018 12;64(12):900-902

An 8-year-old child who lives in a small town has presented to my practice with a 3-inch laceration on the calf that has been assessed and needs repair with sutures. The family lives 4 hours from the nearest emergency department and I was planning to repair the wound in the office. What is the best way to manage pain in young patients needing sutures for laceration repair? Children are particularly susceptible to experiencing high levels of pain and anxiety during routine emergency procedures such as laceration repair. It is important to consider measures to reduce procedural pain. Using needle-free anesthesia, such as the lidocaine-adrenaline-tetracaine combination, might be effective to anesthetize the area. In instances where lidocaine-adrenaline-tetracaine is not sufficient, additional injected lidocaine or bupivacaine can be used. Buffering lidocaine with bicarbonate, warming the lidocaine ampule, and injecting the compound slowly at a perpendicular angle to the skin will reduce pain associated with the injection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371869PMC
December 2018

Second-generation antipsychotics in children: Risks and monitoring needs.

Can Fam Physician 2018 09;64(9):660-662

A 10-year-old male patient presented to my clinic with irritability associated with autism spectrum disorder, and previous therapeutic efforts had not been successful. Treatment with quetiapine has considerably reduced irritability and improved his quality of life; however, the patient's mother has stated that her child's clothes are no longer fitting because his waist size has increased substantially, and that he has gained 5 kg since treatment initiation 8 weeks ago. Should second-generation antipsychotic (SGA) treatment be stopped or continued, and how can these side effects be best mitigated in a family practice setting? Use of SGAs in pediatric patients has increased in recent years, which has brought to light a number of worrisome metabolic side effects that occur in children. Owing to the efficacy of treatment, SGAs must often be continued despite side effects. Even if the drug has been prescribed elsewhere, family physicians should closely monitor these patients following the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children guidelines. When starting an SGA, patients and their families should be educated on the importance of healthy eating and physical activity to preemptively mitigate potential side effects. Recent studies have also shown adjunctive metformin to have a potential role in reducing weight gain.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135131PMC
September 2018

Anhedonia in depression and schizophrenia: A transdiagnostic challenge.

CNS Neurosci Ther 2018 07 23;24(7):615-623. Epub 2018 Apr 23.

Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada.

Background: Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ).

Aims: To elucidate the clinical and neurobiological differences between schizophrenia (SZ) and depression (MDD) in regard to anhedonia, while reconciling the challenges and benefits of assessing anhedonia as a transdiagnostic feature under the Research Domain Criteria (RDoC) framework.

Methods: In this review, we summarize data from publications examining anhedonia or its underlying reward deficits in SZ and MDD. A literature search was conducted in OVID Medline, PsycINFO and EMBASE databases between 2000 and 2017.

Results: While certain subgroups share commonalities, there are also important differences. SZ may be characterized by a disorganization, rather than a deficiency, in reward processing and cognitive function, including inappropriate energy expenditure and focus on irrelevant cues. In contrast, MDD has been characterized by deficits in anticipatory pleasure, development of reward associations, and integration of information from past experience. Understanding the roles of neurotransmitters and aberrant brain circuitry is necessary to appreciate differences in reward function in SZ and MDD.

Conclusion: Anhedonia as a clinical presentation of reward circuit dysregulation is an important and relatively undertreated symptom of both SZ and MDD. In order to improve patient outcomes and quality of life, it is important to consider how anhedonia fits into both diagnoses.
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http://dx.doi.org/10.1111/cns.12854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489811PMC
July 2018

Presentation and Neurobiology of Anhedonia in Mood Disorders: Commonalities and Distinctions.

Curr Psychiatry Rep 2018 03 8;20(2):13. Epub 2018 Mar 8.

Li Ka Shing Knowledge Institute, Arthur Sommer Rotenberg Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, 193 Yonge St, 6-009, Toronto, ON, M5B 1M8, Canada.

Purpose Of Review: To focus on the clinical and behavioral presentation of anhedonia in mood disorders, as well as the differences and commonalities in the underlying neurocircuitry.

Recent Findings: Evidence suggests that depression is characterized by hypofunction of the reward system, while bipolar disorder manifests dysregulation of the behavioral activation system that increases goal-directed reward behavior. Importantly, strong evidence does not exist to suggest significant differences in anhedonia severity between depressed unipolar and bipolar patients, suggesting that there are more nuanced fluctuations in reward processing deficits in bipolar patients depending on their state. Both euthymic unipolar and bipolar patients frequently report residual reward dysfunction, which highlights the potential of reward processing deficits that give rise to the clinical symptom of anhedonia to be trait factors of mood disorders; however, the possibility that therapies are not adequately treating anhedonia could also explain the presence of residual symptoms. Reward processing represents a potential diagnostic and treatment marker for mood disorders. Further research should systematically explore the facets of reward processing in at-risk, affected, and remitted patients.
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http://dx.doi.org/10.1007/s11920-018-0877-zDOI Listing
March 2018