Publications by authors named "Megan Scott"

30 Publications

  • Page 1 of 1

Visual Analytics Dashboard Promises to Improve Hypertension Guideline Implementation.

Am J Hypertens 2021 May 27. Epub 2021 May 27.

Department of Internal Medicine, Henry Ford Hospital and Wayne State University, Detroit, MI, United States.

Background: Primary care management of hypertension under new guidelines incorporates assessment of cardiovascular disease risk and commonly requires review of electronic health record (EHR) data. Visual analytics can streamline the review of complex data and may lessen the burden clinicians face using the EHR. This study sought to assess the utility of a visual analytics dashboard in addition to EHR in managing hypertension in a primary care setting.

Methods: Primary care physicians within an urban, academic internal medicine clinic were tasked with performing two simulated patient encounters for HTN management: the first using standard EHR, and the second using EHR paired with a visual dashboard. The dashboard included graphical blood pressure trends with guideline-directed targets, calculated ASCVD risk score, and relevant medications. Guideline-appropriate antihypertensive prescribing, correct target blood pressure goal, and total encounter time were assessed.

Results: We evaluated 70 case simulations. Use of the dashboard with the EHR compared to use of the EHR alone was associated with greater adherence to prescribing guidelines (95% vs. 62%, p<0.001) and more correct identification of BP target (95% vs. 57%, p<0.01). Total encounter time fell an average of 121 seconds (95% CI 69 - 157 seconds, p<0.001) in encounters that used the dashboard combined with the EHR.

Conclusions: The integration of a hypertension-specific visual analytics dashboard with EHR demonstrates the potential to reduce time and improve hypertension guideline implementation. Further widespread testing in clinical practice is warranted.
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http://dx.doi.org/10.1093/ajh/hpab081DOI Listing
May 2021

A 55-Year-Old Male Presenting With a Lower Extremity Rash: A Case of Immunoglobulin A (IgA) Nephropathy.

Cureus 2021 Mar 29;13(3):e14165. Epub 2021 Mar 29.

Internal Medicine, Henry Ford Health System, Detroit, USA.

Immunoglobulin A (IgA) nephropathy, mesangial deposition of IgA in renal parenchyma, typically presents with hematuria and proteinuria. Leukocytoclastic vasculitis (LCV), a small-vessel vasculitis, can present secondary to IgA. We will discuss a case of secondary IgA nephropathy with concomitant LCV in a patient with reactivated hepatitis C. A 55-year-old male with decompensated alcoholic cirrhosis presented for a bilateral lower-extremity rash. The patient was diagnosed with IgA nephropathy, by kidney biopsy, and skin biopsy showing LCV. Further investigation revealed hepatitis C viral load was 275,000. We present a rare presentation of secondary IgA nephropathy with concomitant LCV, which we hypothesize was secondary to reactivation of hepatitis C.
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http://dx.doi.org/10.7759/cureus.14165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080951PMC
March 2021

Physician-Patient Concordance in the Assessment of Asthma Control.

J Allergy Clin Immunol Pract 2021 Apr 16. Epub 2021 Apr 16.

Adelphi Real World, Bollington, UK.

Background: Discordance between physicians' and patients' perceptions of asthma control may negatively impact symptom control, treatment, and outcomes.

Objective: To evaluate concordance between physicians' and patients' perceptions of overall asthma control and the association between perceived overall control and individual components of control.

Methods: U.S. survey data (Dec 2015-Feb 2016; Apr-Aug 2018) from the Respiratory Disease Specific Programme were analyzed. Physicians recorded patient disease characteristics and their perception of patients' asthma control. Patients' perception of control was assessed using the Asthma Control Test; responses were compared with level of symptom control per the Global Initiative for Asthma criteria and Work Productivity and Impairment questionnaire responses. Agreement and association were assessed by weighted kappa (κ) and Spearman rho (ρ), respectively.

Results: The study included 1,288 patients. Concordance between physician-perceived and patient-perceived asthma control in the prior 4 weeks was moderate (κ = 0.4951). Association between physicians' overall perception of asthma control and patients' overall Asthma Control Test score was also moderate (ρ = 0.5450). However, 61.5% of patients with self-reported, well-controlled asthma had shortness of breath 1 to 2 times/wk, 45.6% had 1 to 2 night-time awakenings/wk, and patients reported a mean (SD) daily activity impairment of 17.5% (16.2%). Only 21.8% of patients with self-reported, well-controlled asthma were classified as such by Global Initiative for Asthma symptom criteria.

Conclusions: Patients' self-assessment of overall control does not accurately characterize the true level of control; thus, patients and physicians may benefit from working together to assess the individual components of asthma control to achieve better disease management, treatment decisions, and improved outcomes.
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http://dx.doi.org/10.1016/j.jaip.2021.03.056DOI Listing
April 2021

Nurses' Perceptions of Rooming-in for Caregivers of Infants with CCHD.

J Pediatr Nurs 2021 Jan-Feb;56:101-102. Epub 2020 Aug 20.

Nell Hodgson Woodruff School of Nursing, Emory University, GA 30322, United States of America. Electronic address:

Congenital heart disease (CHD) is the most common congenital defect. Infants with critical congenital heart disease (CCHD) require complex medical care, and their caregivers need extensive training before being discharged home to safely care for their child. The rooming-in process provides caregivers with an opportunity to learn, practice, and manage the skills required for discharge to home during hospitalization. Although the literature reflects positive implications for the use of the rooming-in process in other populations (e.g., neonatal abstinence syndrome), literature about the rooming-in process in a pediatric cardiac care setting is limited. There remains a gap in the literature pertaining to the viewpoints of nurses, specifically as it relates to implementing a rooming-in process. Therefore, a qualitative study design was chosen to explore the nurses' perceptions of the rooming-in process using focus groups. The purpose of this study was to gain insight from nurses as to strategies to enhance the rooming-in process for caregivers of infants with CCHD. Additionally, we explored potential education and interventions to improve outcomes for infants with CCHD preparing to be discharged home.
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http://dx.doi.org/10.1016/j.pedn.2020.08.008DOI Listing
April 2021

Tobacco-use behavior and toxicant exposure among current dual users of electronic cigarettes and tobacco cigarettes.

Exp Clin Psychopharmacol 2020 Jul 13. Epub 2020 Jul 13.

Department of Psychology, Virginia Commonwealth University.

Electronic cigarette (e-cigarette) use continues to grow with most users reporting concurrent cigarette smoking, but few studies have focused on tobacco use and toxicant exposure among naturalistic dual-using populations. This controlled clinical laboratory study examined how dual versus exclusive use of e-cigarettes and cigarettes and no tobacco/nicotine affected behavioral, physiological, and subjective measures among current dual users. Twenty-two participants identifying as cigarette (≥ 10 cigarettes per day [CPD]) and e-cigarette (≥ 3 days/week) users of "cig-a-like" e-cigarettes completed four 5-day outpatient conditions, which differed by their own brand of products used ad libitum: (a) cigarette and e-cigarette (dual), (b) cigarette-only, (c) e-cigarette-only, and (d) no tobacco/nicotine. Primary outcomes included daily tobacco use, expired air carbon monoxide (CO), and urinary cotinine and NNAL. Linear mixed models with pairwise comparisons (Bonferroni corrected) were performed (p < .05). CPD did not differ significantly between dual and cigarette-only use, but e-cigarette use and liquid consumed increased significantly during e-cigarette-only relative to dual use. Relative to dual use, expired air CO did not differ during cigarette-only and was significantly lower during e-cigarette-only use. Urinary cotinine was significantly lower during e-cigarette-only use relative to dual and cigarette-only use, while urinary NNAL did not differ between the nicotine-containing conditions. In summary, among current dual users, e-cigarettes in combination with cigarettes did not reduce CPD relative to exclusive cigarette use or toxicant exposure relative to exclusive use of either product. However, exclusive e-cigarette use did reduce CO and cotinine, highlighting the benefits of cigarette cessation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000417DOI Listing
July 2020

Unmasking lymphoma immune reconstitution inflammatory syndrome in a patient with pyrexia of unknown origin: a case report.

J Egypt Natl Canc Inst 2020 Jan 30;32(1). Epub 2020 Jan 30.

Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.

Background: Immune reconstitution inflammatory syndrome (IRIS) is a constellation of inflammatory disorders that are unmasked after the initiation of anti-retroviral therapy (ART) in Human immunodeficiency virus (HIV) infected patients. Unmasking lymphoma IRIS is a relatively rare manifestation after initiation of anti-retroviral therapy.

Case Presentation: We report a 44-year-old male with HIV on 4 months of ART presenting with pyrexia of unknown origin with a diagnosis of unmasking Hodgkin's lymphoma IRIS stage IV with B symptoms. This case portrays the importance of recognizing the possibility of Hodgkin's lymphoma as a possible manifestation of IRIS within the first 6 months of initiation of ART.

Conclusion: Patients presenting with pyrexia of unknown origin and lymphadenopathy within the first 6 months of initiation of ART, lymphoma diagnosis should be on the high threshold of suspicion as portrayed by our case.
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http://dx.doi.org/10.1186/s43046-020-0019-7DOI Listing
January 2020

Further development of a reverse-transcription loop-mediated isothermal amplification (RT-LAMP) assay for the detection of foot-and-mouth disease virus and validation in the field with use of an internal positive control.

Transbound Emerg Dis 2020 Nov 6;67(6):2494-2506. Epub 2020 May 6.

Department of Jobs, Precincts and Regions, Agriculture Victoria Research, AgriBio, Bundoora, Vic., Australia.

Foot-and-mouth disease (FMD) is a highly contagious viral disease of cloven-hooved animals. Global outbreaks have highlighted the significant economic, trade, psychosocial and animal welfare impacts that can arise from the detection of disease in previously 'FMD-free' countries. Rapid and early diagnosis provides significant advantages in disease control and minimization of deleterious consequences. We describe the process of further development and validation of a reverse-transcription loop-mediated isothermal amplification foot-and-mouth disease virus (RT-LAMP-FMDV) test, using a published LAMP primer set, for use in the field. An internal positive control (IPC) was designed and introduced for use with the assay to mitigate any intrinsic interference from the unextracted field samples and avoid false negatives. Further modifications were included to improve the speed and operability of the test, for use by non-laboratory trained staff operating under field conditions, with shelf-stable reaction kits which require a minimum of liquid handling skills. Comparison of the assay performance with an established laboratory-based real-time reverse transcriptase PCR (rRT-PCR) test targeting the 3D region of FMD virus (Tetracore Inc) was investigated. LAMP has the potential to complement current laboratory diagnostics, such as rRT-PCR, as a preliminary tool in the investigation of FMD. We describe a strategic approach to validation of the test for use in the field using extracted RNA samples of various serotypes from Thailand and then finally unextracted field samples collected from FMD-suspected animals (primarily oral lesion swabs) from Bhutan and Australia. The statistical approach to validation was performed by Frequentist and Bayesian latent class methods, which both confirmed this new RT-LAMP-FMDV test as fit-for-purpose as a herd diagnostic tool with diagnostic specificity >99% and sensitivity 79% (95% Bayesian credible interval: 65, 90%) on unextracted field samples (oral swabs).
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http://dx.doi.org/10.1111/tbed.13589DOI Listing
November 2020

Outcomes of Cataract Surgery Complicated by Retained Lens Fragments Requiring Pars Plana Vitrectomy.

Clin Ophthalmol 2020 26;14:939-946. Epub 2020 Mar 26.

Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.

Objective: To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees.

Methods: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20).

Main Outcomes/measures: Visual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression.

Results: The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p<0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3).

Conclusions/relevance: Despite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.
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http://dx.doi.org/10.2147/OPTH.S239100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112746PMC
March 2020

Bench, bed and beyond: Communication and responsibility in decentralised tuberculosis care.

Health SA 2019 30;24:1208. Epub 2019 Sep 30.

Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.

Background: South Africa faces one of the world's worst drug-resistant tuberculosis epidemics. Implementing successful care in this context has proven challenging for a number of reasons. Communication is an essential yet neglected feature of care and research in the field of tuberculosis.

Aim: The primary aim of this qualitative study was to explore communication facilitators and barriers at several tuberculosis care sites. In this article, we focus on communication practices across the chain of diagnosis, treatment, discharge and follow-up in decentralised care approaches and present evidence of gaps in communication.

Setting: The study was conducted at three tuberculosis care sites in two South African provinces.

Methods: Participants included healthcare workers, patients, community members and home-based carers. Data included 79 interviews, 4 video-recorded interactions between patients and healthcare workers, and ethnographic observations at each site. We analysed the data using thematic analysis and a qualitative sociolinguistic framework.

Results: Communication in decentralised care contexts is complex because of multiple sites and role players. Responsibility for communication seems to be unduly placed on patients, treatment guidelines are not implemented consistently across sites and assumptions are made about the role of others in the chain. Patient and healthcare worker reports suggest confusion and frustration.

Conclusion: Communication in the South African tuberculosis care context appears fragile and current mechanisms for detecting flaws in the care chain are not sensitive to communication issues. We make recommendations for strengthening home-based care resources, providing team training and focusing on communication processes in monitoring and evaluating systems.
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http://dx.doi.org/10.4102/hsag.v24i0.1208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917390PMC
September 2019

Video-recording complex health interactions in a diverse setting: Ethical dilemmas, reflections and recommendations.

Dev World Bioeth 2020 03 19;20(1):16-26. Epub 2019 Mar 19.

Video-recording healthcare interactions provides important opportunities for research and service improvement. However, this method brings about tensions, especially when recording sensitive topics. Subsequent reflection may compel the researcher to engage in ethical and moral deliberations. This paper presents experiences from a South African genetic counselling study which made use of video-recordings to understand communicative processes in routine practice. Video-recording as a research method, as well as contextual and process considerations are discussed, such as researching one's own field, issues of trust and anonymity, the challenge of providing true informed consent and capturing details which may cause psychological harm. Several recommendations for research practice in diverse healthcare settings are made. This includes the value of reflective pieces, the importance of retrospective consent, disclosure of the limitations to anonymity, as well as the collective responsibility of those involved to produce ethical research. These recommendations have value for genetic counselling and other healthcare fields.
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http://dx.doi.org/10.1111/dewb.12226DOI Listing
March 2020

Perceived challenges in the informed consent process: Mismatches between enrollers and researchers at a South African clinical research site.

Dev World Bioeth 2019 12 29;19(4):206-214. Epub 2019 Jan 29.

Enrollers play a critical yet often overlooked role in clinical research, particularly in informed consent processes. Study retention may depend in part on how complex information is conveyed to potential participants. This qualitative study aimed to assess communicative barriers during consent and enrolment in two South African TB/HIV clinical studies. In particular, we compared our own perceptions of potential challenges to consent with that of thirteen enrollers, gained via reflective journaling and focus group discussions. Some overlap of identified challenges was evident, including terminology, jargon and consent document format. However there were mismatches to identified challenges. Enrollers provided further insights into potential challenges to consent, in particular, blood withdrawal, discussion of sexual issues and misunderstanding of study participation. Enrollers also reported feeling ill-equipped to provide counselling when participants became distressed. We offer several recommendations for strengthening the inclusion of enrollers in the development of clinical research protocols and consent documents.
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http://dx.doi.org/10.1111/dewb.12218DOI Listing
December 2019

Antecedents of Screening Positive for Attention Deficit Hyperactivity Disorder in Ten-Year-Old Children Born Extremely Preterm.

Pediatr Neurol 2018 04 21;81:25-30. Epub 2017 Dec 21.

Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.

Background: The incidence of attention deficit hyperactivity disorder is higher among children born very preterm than among children who are mature at birth.

Methods: We studied 583 ten-year-old children who were born before 28 weeks of gestation whose IQ was above 84 and had a parent-completed Child Symptom Inventory-4, which allowed classification of the child as having or not having symptoms of attention deficit hyperactivity disorder. For 422 children, we also had a teacher report, and for 583 children, we also had a parent report of whether or not a physician made an attention deficit hyperactivity disorder diagnosis.

Results: The risk profile of screening positive for attention deficit hyperactivity disorder based on a parent's report differed from the risk profile based on the teacher's report, whereas the risk profile according to a physician and according to any two observers closely resembled the parent-reported profile. Among the statistically significant risk factors were young maternal age (parent, physician, and two observers), maternal obesity (parent, physician, and two observers), maternal smoking (parent, physician, and two observers), magnesium given at delivery for seizure prophylaxis (parent and two observers), recovery of Mycoplasma sp. from the placenta (teacher and two observers), low gestational age (parent and two observers), low birth weight (teacher and physician), singleton (parent, physician, and two observers), male (parent, teacher, physician, and two observers), mechanical ventilation on postnatal day seven (physician), receipt of a sedative (parent and two observers), retinopathy of prematurity (parent), necrotizing enterocolitis (physician), antibiotic receipt (physician and two observers), and ventriculomegaly on brain scan (parent and two observers).

Conclusions: The multiplicity of risk factors identified can be subsumed as components of four broad themes: low socioeconomic state, immaturity or vulnerability, inflammation, and epigenetic phenomena.
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http://dx.doi.org/10.1016/j.pediatrneurol.2017.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903941PMC
April 2018

Maternal obesity and attention-related symptoms in the preterm offspring.

Early Hum Dev 2017 12 17;115:9-15. Epub 2017 Aug 17.

Neuroepidemiology Unit, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.

Background: Maternal pre-pregnancy obesity, in term-born children, is associated with an increased risk of attention problems, however this relationship has not been explored among children born extremely preterm.

Aim: To estimate the risk of attention problems at age 10years in children born very preterm to overweight (i.e., body mass index (BMI) 25-29kg/m) and obese (i.e., BMI≥30kg/m) women relative to the risk among children born to women who were neither overweight nor obese (i.e. BMI<25kg/m).

Study Design: Multi-center prospective cohort study.

Methods: A total of 764 children born before the 28th week of gestation and whose mother's pre-pregnancy height and pre-pregnancy weight were obtained at birth had an IQ≥70 at age 10years when parents and teachers completed Child Symptom Inventory-4 questionnaires that included items about the presence of ADHD.

Results: Compared to children whose mother's pre-pregnancy weight was in the normal range (BMI<25kg/m), children were at increased risk of parent-identified ADHD behaviors if their mother was overweight (odds ratio (OR)=1.9; 95% confidence interval (CI): 1.1, 3.3), or obese (OR=2.3; 95% CI: 1.4, 3.9). They were not at increased risk of teacher-identified ADHD characteristics if their mother was overweight before her pregnancy (OR=1.0; 95% CI: 0.6, 1.8), or obese (OR=1.0; 95% CI: 0.6, 1.6).

Conclusion: Maternal overweight and obesity are associated with increased risk of parent-identified ADHD characteristics at 10years of age in children born extremely preterm.
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http://dx.doi.org/10.1016/j.earlhumdev.2017.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082429PMC
December 2017

Pathogenetic Analysis of Sinonasal Teratocarcinosarcomas Reveal Actionable β-catenin Overexpression and a β-catenin Mutation.

J Neurol Surg B Skull Base 2017 Aug 27;78(4):346-352. Epub 2017 Mar 27.

Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States.

 Sinonasal teratocarcinosarcomas are rare, aggressive tumors of the skull base. Treatment options are limited and outcomes are poor. Little is known in regard to the genetic factors regulating these tumors. Characterization of actionable molecular alterations in these tumors could provide potentially successful therapeutic options.  We performed targeted exome sequencing on an index sinonasal teratocarcinosarcoma specimen to identify potential driver mutations. We performed immunohistochemical stains for β-catenin on paraffin-embedded tissue on the index tumor and a subsequent teratocarcinosarcoma. Online databases of cancer mutations (Catalogue of Somatic Mutations in Cancer and The Cancer Genome Atlas) were accessed.  We identified an activating p.S45F mutation in β-catenin in our index sinonasal teratocarcinosarcoma. This mutation results in constitutive signaling in the Wnt/β-catenin pathway. We confirmed β-catenin overexpression and nuclear localization via immunohistochemistry in the index tumor and a second patient. The p.S45F activating mutation was found in a variety of solid tumors, and accounts for 3.3 to 10.4% of all known β-catenin mutations.  We identified a potential driver mutation in β-catenin in a sinonasal teratocarcinosarcoma, resulting in β-catenin overexpression. These findings suggest a role for the Wnt/β-catenin pathway in sinonasal teratocarcinosarcoma tumorigenesis and a role for anti-β-catenin targeted therapy.
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http://dx.doi.org/10.1055/s-0037-1601320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515660PMC
August 2017

Neurocognitive Correlates of Attention-Deficit Hyperactivity Disorder Symptoms in Children Born at Extremely Low Gestational Age.

J Dev Behav Pediatr 2017 May;38(4):249-259

*Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL; †Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA; ‡Division of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; §Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC; Departments of ‖Neurology and ¶Neurology Research, Boston Children's Hospital and Harvard Medical School, Boston MA; **Division of Pediatric Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA.

Objective: Compared with children born near term, those born extremely preterm (EP) are at much higher risk for attention-deficit hyperactivity disorder (ADHD). Little information is available about differences in neuropsychological outcomes among EP children with and without ADHD. Our analyses aimed to evaluate the neuropsychological correlates of ADHD symptoms in extremely low gestational age newborns (ELGANs).

Methods: We obtained Child Symptom Inventory-4 reports from parents (n = 871) and teachers (n = 634) of 10-year-old children born before the 28th week of gestation. Participants completed standardized assessments of neurocognitive and academic functioning.

Results: In the total sample, children who screened positive for ADHD symptoms were at increased risk for neurocognitive limitations. These associations were weaker when the sample was limited to those with intelligence quotient (IQ) ≥70 or ≥85. Even those with IQ ≥85 who screened positive for ADHD symptoms were more likely than their peers to have deficits on the DAS-II Working Memory Cluster and the NEPSY-II Auditory Response subtest. The risks for impaired academic performance (Z ≤ -1) on components of the WIAT-III were 2-to-3 times higher in this group than among ELGANs not classified as having ADHD symptoms.

Conclusion: Among children born EP, those with ADHD symptoms are more likely to have global neurocognitive impairment. When IQ is within normal limits, ADHD symptoms are associated with deficits in executive functioning skills. These findings highlight a group at risk for executive functioning deficits and related academic difficulties, even in the absence of intellectual disability.
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http://dx.doi.org/10.1097/DBP.0000000000000436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746049PMC
May 2017

Systemic Inflammation during the First Postnatal Month and the Risk of Attention Deficit Hyperactivity Disorder Characteristics among 10 year-old Children Born Extremely Preterm.

J Neuroimmune Pharmacol 2017 09 12;12(3):531-543. Epub 2017 Apr 12.

The University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA.

Although multiple sources link inflammation with attention difficulties, the only human study that evaluated the relationship between systemic inflammation and attention problems assessed attention at age 2 years. Parent and/or teacher completion of the Childhood Symptom Inventory-4 (CSI-4) provided information about characteristics that screen for attention deficit hyperactive disorder (ADHD) among 793 10-year-old children born before the 28th week of gestation who had an IQ ≥ 70. The concentrations of 27 proteins in blood spots obtained during the first postnatal month were measured. 151 children with ADHD behaviors were identified by parent report, while 128 children were identified by teacher report. Top-quartile concentrations of IL-6R, TNF-α, IL-8, VEGF, VEFG-R1, and VEGF-R2 on multiple days were associated with increased risk of ADHD symptoms as assessed by a teacher. Some of this increased risk was modulated by top-quartile concentrations of IL-6R, RANTES, EPO, NT-4, BDNF, bFGF, IGF-1, PIGF, Ang-1, and Ang-2. Systemic inflammation during the first postnatal month among children born extremely preterm appears to increase the risk of teacher-identified ADHD characteristics, and high concentrations of proteins with neurotrophic properties appear capable of modulating this increased risk.
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http://dx.doi.org/10.1007/s11481-017-9742-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508968PMC
September 2017

Observer variability identifying attention deficit/hyperactivity disorder in 10-year-old children born extremely preterm.

Acta Paediatr 2017 Aug 11;106(8):1317-1322. Epub 2017 May 11.

Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.

Aim: A DSM-5 diagnosis of attention deficit/hyperactive disorder (ADHD) requires that symptoms be present in two settings. We wanted to see how teachers and parents compare on their assessments.

Methods: We evaluated how well Child Symptom Inventory-4 (CSI-4) reports from 871 parents and 634 teachers of 10-year-old children born before the 28th week of gestation provided information about indicators of school dysfunction.

Results: Kappa values for parent and teacher agreement of any ADHD were at best fair to poor (<0.41). Nevertheless, ADHD identified by each alone provided a moderate amount of information about such indicators of school dysfunction as grade repetition. Only occasionally did agreement provide more information than provided by only one reporter. Mother's social class and intelligence level did not discriminate between parents who did and did not agree with the teacher.

Conclusion: ADHD identified by a single observer can provide appreciable information about a range of the child's functions needed for success in school and, therefore, should not be discounted when another observer does not consider the child to have ADHD symptoms.
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http://dx.doi.org/10.1111/apa.13869DOI Listing
August 2017

Acute Eye Pain Following Prolonged Face-Down Positioning in a Patient With Marfan Syndrome.

JAMA Ophthalmol 2017 03;135(3):277-278

Department of Ophthalmology, Baylor College of Medicine-Cullen Eye Institute, Houston, Texas.

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http://dx.doi.org/10.1001/jamaophthalmol.2016.3778DOI Listing
March 2017

'Nurses don't deal with these issues': nurses' role in advance care planning for lesbian, gay, bisexual and transgender patients.

J Clin Nurs 2016 Dec 25;25(23-24):3707-3715. Epub 2016 Jul 25.

School of Nursing, San Francisco State University, San Francisco, CA, USA.

Aims And Objectives: We used a question from the Healthcare Equality Index to explore nurses' knowledge and understanding of medical advance directives, medical power of attorney and other legal documents for lesbian, gay, bisexual and transgender patients.

Background: Until the landmark ruling in Obergefell vs. Hodges, lesbian, gay, bisexual and transgender individuals and same-sex couples have had limited relationship rights as only a few states recognised marriages and provided legal protections for same-sex couples. Health care providers' knowledge of and attitudes towards advance care planning plays a significant role in determining whether or not individuals successfully complete advance directives, yet advance care planning for lesbian, gay, bisexual and transgender individuals is poorly understood among both health care providers and same-sex couples.

Design: These data were part of a larger research study that explored the current state of lesbian, gay, bisexual and transgender-sensitive nursing practice.

Method: Undergraduate nursing students recruited and interviewed nurse key informants (n = 268) about medical advance directives, medical power of attorney and other legal documents for lesbian, gay, bisexual and transgender patients.

Results: Nearly 50% of key informants indicated a lack of knowledge of advance directives, over 26% reported the difficulties nurses face regarding advance directives are the same for both lesbian, gay, bisexual and transgender and heterosexual patients, and nearly 25% indicated difficulties including having to decide who has the legal right to make decisions for the patient.

Conclusion: The study demonstrated the need for education and training for practising nurses in advance care planning for lesbian, gay, bisexual and transgender patients and same-sex couples.

Relevance To Clinical Practice: Nurses are in a position to act as educators, advocates and decision makers for their patients. Nurse's lack of understanding of advance care planning may negatively impact the type and quality of care lesbian, gay, bisexual and transgender patients receive.
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http://dx.doi.org/10.1111/jocn.13336DOI Listing
December 2016

In vivo Wnt pathway inhibition of human squamous cell carcinoma growth and metastasis in the chick chorioallantoic model.

J Otolaryngol Head Neck Surg 2016 Apr 26;45:26. Epub 2016 Apr 26.

Department of Otolaryngology/Head Neck Surgery, University of Michigan School of Medicine, Ann Arbor, MI, 48109-5616, USA.

Background: Head and neck squamous cell carcinoma (HNSCC) is an aggressive cancer with poor overall survival. New therapeutic strategies that target specific molecular lesions driving advanced disease are needed. Herein we demonstrate the utility of the chicken chorioallantoic membrane (CAM) assay for in vivo human HNSCC tumor growth and metastasis and the tumor suppressive effects of a new chemotherapeutic agent.

Methods: We tested anti-metastatic effects of a WNT pathway inhibitor, WNT974 (also known as LGK974), which targets porcupine (PORCN) the palmityl-transferase that is essential for secretion of Wnt proteins. CAM assays were performed with 8 HNSCC cell lines: UM-SCC-1, UM-SCC-10A, UM-SCC-10B, UM-SCC-11A, UM-SCC-14A UM-SCC-17A, UM-SCC-17B, UM-SCC-25, and UM-SCC-34.

Results: UM-SCC-1 (University of Michigan Squamous Cell Carcinoma cell line) CAM xenografts contain CD44+ and ALDH+ cancer stem cell (CSC) proportions similar to UM-SCC-1 mouse xenografts supporting the applicability of the CAM assay for study of CSCs. Inhibition of WNT signaling by the PORCN inhibitor WNT974 reduced metastatic spread of UM-SCC cells, especially in UM-SCCs with Notch1 deficiency.

Conclusions: Our data demonstrate decreased tumor growth and metastases in tumors from cell lines that showed in vitro responses to WNT974, providing evidence that this agent may have a role in future HNSCC therapy.
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http://dx.doi.org/10.1186/s40463-016-0140-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845503PMC
April 2016

Identification of Targetable ERBB2 Aberrations in Head and Neck Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg 2016 06;142(6):559-67

Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor3Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor.

Importance: ERBB2 (formerly HER2) is an important drug target in breast cancer, where anti-ERBB2 therapy has been shown to lead to improvements in disease recurrence and overall survival. ERBB2 status in head and neck squamous cell carcinoma (HNSCC) has not been well studied. Identification of ERBB2-positive tumors and characterization of response to ERBB2 therapy could lead to targeted treatment options in HNSCC.

Objective: To identify ERBB2 aberrations in HNSCCs and investigate the potential for ERBB2-targeted therapy in HNSCCs.

Design, Setting, And Participants: A retrospective case series of patients with laryngeal (42 tumor specimens) and oral cavity (94 tumor specimens) SCC enrolled in the University of Michigan Head and Neck Specialized Program of Research Excellence was conducted. Publicly available sequencing data (The Cancer Genome Atlas), as well as data from other studies, were reviewed to identify additional mutations and overexpression in ERBB2 in HNSCC. Established HNSCC cell lines were used for follow-up in vitro analysis. The study was conducted from October 1, 2014, to August 30, 2015.

Interventions: With the use of targeted, amplicon-based sequencing with the Oncomine Cancer Panel, the copy number and mutation status of commonly altered genes in HNSCCs were assessed. Immunohistochemical staining was performed on tissue microarrays of HNSCCs to assess the expression of ERBB2. Western blotting for HNSCC cell line ERBB2 expression and cell survival assays after treatment with ERBB2 inhibitors were performed.

Main Outcomes And Measures: The prevalence of ERBB2 genetic aberrations and ERBB2 overexpression in laryngeal and oral cavity SCCs, prevalence of ERBB2 aberrations in HNSCC in The Cancer Genome Atlas, ERBB2 protein expression in HNSCC cell lines, and response of HNSCC cell lines to targeted ERBB2 inhibitors.

Results: Of the 42 laryngeal SCC samples screened by targeted sequencing, 4 (10%) were positive for ERBB2 amplification. Two of these samples showed ERBB2 overexpression on immunohistochemistry. Two of the 94 oral cavity SCC samples (2%) were positive for ERBB2 on immunohistochemistry. Analysis of 288 patients from publicly available HNSCC sequencing data revealed 9 amplifications (3%) in ERBB2. Protein expression was variable across HNSCC cell lines, and a subset of these cell lines showed responsiveness to anti-ERBB2 therapy.

Conclusions And Relevance: ERBB2 aberrations were identified in a subset of HNSCCs. These tumors may be responsive to targeted therapy against ERBB2. Screening for ERBB2 aberrations and applying targeted therapy in ERBB2-positive patients may be useful in personalized therapy trials, particularly in patients who are refractory to current treatment paradigms.
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http://dx.doi.org/10.1001/jamaoto.2016.0335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911238PMC
June 2016

Does your organization use gender inclusive forms? Nurses' confusion about trans* terminology.

J Clin Nurs 2015 Nov 12;24(21-22):3306-17. Epub 2015 Aug 12.

School of Nursing, San Francisco State University, San Francisco, CA, USA.

Aims And Objectives: To describe nurses confusion around trans* terminology and to provide a lesson in Trans* 101 for readers.

Background: Of the estimated 9 million persons in the United States of America who are identified as lesbian, gay, bisexual and transgender, about 950,000 (0.2-0.5% of adult population) are identified as trans* (a term that encompasses the spectrum, including transgender, transsexual, trans man, trans woman and other terms). The Institute of Medicine (2011, The health of lesbian, gay, bisexual and transgender people: Building a foundation for better understanding. The National Academies Press, Washington, DC) identified transgender persons as an understudied population with significant need for health research, yet the nursing literature contains little guidance for educating nurses on trans* issues.

Design: This is a mixed methods structured interview design with nurse key informants. The scripted interview was based on the Health Care Equality Index, which evaluates patient-centred care to lesbian, gay, bisexual and transgender patients and families. These data were part of a larger research study that explored the current state of lesbian, gay, bisexual and transgender-sensitive nursing practice.

Method: Undergraduate nursing students recruited and interviewed 268 nurse key informants about gender inclusive forms (capable of identifying trans* patients) at their agencies.

Results: Only 5% reported use of gender inclusive forms, 44% did not know about inclusive forms, 37% did not understand what a gender inclusive form was and 14% confused gender with sexual orientation.

Conclusion: The study demonstrated a critical need for education in gender identity and sexual orientation terminology.

Relevance To Clinical Practice: The lack of understanding of concepts and terminology may affect basic care of lesbian, gay, bisexual and transgender patients especially those who identify as transgender.
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http://dx.doi.org/10.1111/jocn.12942DOI Listing
November 2015

"Never in All My Years... ": Nurses' Education About LGBT Health.

J Prof Nurs 2015 Jul-Aug;31(4):323-9. Epub 2015 Jan 30.

Student School of Nursing, San Francisco State University, San Francisco, CA 94132.

In spite of recent calls for patient-centered care and greater attention to the needs of lesbian, gay, bisexual, and transgender (LGBT) patients, nurses still lack basic education about LGBT patient care and, as a result, may have negative attitudes, endorse stereotypes, and/or feel uncomfortable providing care. This study reports on education/training of practicing nurses and explores some of the reasons for nurses reporting feelings of discomfort with LGBT patient care. Transcripts from structured interviews with 268 nurses in the San Francisco Bay Area revealed that 80% had no education or training on LGBT issues. Although most said they were comfortable with LGBT patient care, some of their comments indicated that they might not be providing culturally sensitive care. Implications for nursing education and for policies and procedures of health care institutions are addressed.
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http://dx.doi.org/10.1016/j.profnurs.2015.01.003DOI Listing
January 2017

Nocardia veterana endogenous endophthalmitis in a cardiac transplant patient.

J Ophthalmic Inflamm Infect 2013 Mar 30;3(1):44. Epub 2013 Mar 30.

Division of Vitreoretinal Surgery and Disease, Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.

Background: Endogenous endophthalmitis secondary to Nocardia species is extremely rare but often portends a poor visual prognosis often owing to the advanced nature of disease at presentation and delay in diagnosis. Patients who are systemically immunosuppressed are at greatest risk and early suspicion of the role of this organism in patients with acute panuveitis is paramount.

Findings: A 66-year-old cardiac transplant patient on oral prednisone, Myfortic, and tacrolimus developed unilateral panuveitis with a focal white subretinal and retinal lesion. His past medical history was notable for Aspergillus pneumonia and cytomegalovirus retinitis in the contralateral eye 12 months prior. Aqueous humor sampling for eubacterial, eufungal, and viral PCR testing, as well as vitreous cultures for bacteria and fungi were unsuccessful in the identification of a causative organism. Progressive enlargement of the lesion was noted despite intravitreal foscarnet, vancomycin, ceftazidime, and voriconazole. A pars plana vitrectomy and retinal and subretinal biopsy led to the identification of Nocardia veterana, a recently identified Nocardia species. A combination of linezolid, meropenem, azithromycin, ceftriaxone, and intravitreal amikacin resulted in eradication of the infection.

Conclusion: This is the first reported case of N. veterana endogenous endophthalmitis in an immunosuppressed patient. Pars plana vitrectomy with a subretinal biopsy was required to establish a diagnosis, as other testing including aqueous PCR and vitreous cultures were negative. The poor visual outcome in our patient highlights the importance of early consideration of Nocardia in the differential diagnosis of panuveitis with subretinal disease in the context of immunosuppression.
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http://dx.doi.org/10.1186/1869-5760-3-44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636104PMC
March 2013

Behavior disorders in extremely preterm/extremely low birth weight children in kindergarten.

J Dev Behav Pediatr 2012 Apr;33(3):202-13

Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.

Objective: To examine the prevalence of behavior disorders in a 2001-2003 birth cohort of extremely preterm/extremely low birth weight (EPT/ELBW, <28 weeks gestational age or <1000 g) children in kindergarten.

Method: We compared 148 EPT/ELBW children with 111 term-born normal birth weight classmate controls on reports of psychiatric symptoms obtained from parent interview (Children's Interview for Psychiatric Syndromes-Parent Form [P-ChIPS]), parent and teacher ratings of behavior (Child Behavior Checklist, Teacher's Report Form, and Behavior Rating Inventory of Executive Function), and teacher ratings of social functioning (School Social Behavior Scales, second edition). Associations of behavior disorders with global cognitive ability and tests of executive function were also examined within the EPT/ELBW group.

Results: Rates of attention-deficit/hyperactivity disorder combined on psychiatric interview were about twice as high for the EPT/ELBW group than for the normal birth weight group, odds ratio (95% confidence interval) = 2.50 (1.34, 4.68), p = .004. The EPT/ELBW group also had much higher rates of teacher-identified disorders in attention, behavior self-regulation, and social functioning, with odds ratios (95% confidence intervals) ranging from 3.35 (1.64, 6.83) to 18.03 (4.12, 78.94), all p values <.01. Attention-deficit/hyperactivity disorder and impaired behavior self-regulation were associated with deficits on tests of executive function but not with global cognitive impairment.

Conclusions: The findings document increased rates of disorders in attention, behavior self-regulation, and socialization in EPT/ELBW children and suggest that deficits on tests of executive function are associated with some of these disorders. Early identification and intervention for these disorders are needed to promote early adjustment to school and facilitate learning progress.
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http://dx.doi.org/10.1097/DBP.0b013e3182475287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319865PMC
April 2012

Neurocognitive profile in a case of maple syrup urine disease.

Clin Neuropsychol 2010 May 2;24(4):689-700. Epub 2010 Mar 2.

Children's National Medical Center, Washington, DC 20010, USA.

Maple Syrup Urine Disease (MSUD) is a metabolic disease with associated enzyme deficiency and an inability to break down amino acids. Neurotoxic levels can occur resulting in neurological sequelae. Information regarding cognitive functions has suggested greater verbal than visuospatial abilities. Specific neuropsychological functions have not been studied. The objective of this study is to examine the neuropsychological profile in a case of MSUD. We present a case study of a 7-year-old female who has a history of late diagnosis (7 days of age) and poor metabolic control. Consistent with existing literature, a profile of stronger verbal reasoning and memory skills compared with visual-perceptual and nonverbal memory was revealed. Additional weaknesses were demonstrated with attention, emerging executive functions, and fine motor control. The results suggest that while previously described nonverbal reasoning and visuospatial impairments are present, there is likely a more complex pattern of neuropsychological impairments in children with MSUD, especially those with poor metabolic control.
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http://dx.doi.org/10.1080/13854040903527279DOI Listing
May 2010

An open trial of adjunctive donepezil in attention-deficit/hyperactivity disorder.

J Child Adolesc Psychopharmacol 2005 Dec;15(6):947-55

Pediatric Psychopharmacology Unit, YAW 6A, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.

Objective: Despite available pharmacotherapeutics, a number of youths with attentiondeficit/ hyperactivity disorder (ADHD) continue to experience residual symptoms and prominent executive function (EF) deficits resulting in impairment in multiple domains. We sought to determine if donepezil, used adjunctively to stimulant medication, would improve residual symptoms of ADHD and EF deficits.

Methods: In a 12-week open trial, we treated 7 children and 6 adults who had ADHD and evidence of further EF deficits with adjunctive donepezil. All subjects were stabilized on stimulants, at which time donepezil was initiated at 2.5 mg daily and increased to a maximum of 10 mg over the 12-week trial.

Results: Of 13 subjects receiving medication, 7 completed the trial. There was no clinically or statistically significant improvement in the ADHD Rating Scale and the Executive Function Checklist, our primary outcome measures. A majority of individuals experienced nonserious adverse events.

Conclusions: Results of this small open study suggest that donepezil augmentation of stimulants is not well tolerated and does not appear useful for the treatment of residual ADHD and/or EF deficits.
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http://dx.doi.org/10.1089/cap.2005.15.947DOI Listing
December 2005

Childhood antecedents to panic disorder in referred and nonreferred adults.

J Child Adolesc Psychopharmacol 2005 Aug;15(4):549-61

Pediatric Psychopharmacology Clinic, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

Objective: We used a recursive partitioning method to examine antecedent childhood anxiety disorders in large samples of referred and nonreferred subjects with and without panic disorder.

Methods: Referred subjects included adults treated for panic disorder (n = 131) and comparison adults with neither major anxiety nor mood disorders (n = 61). The nonreferred adult group derived from an opportunistic sample originally ascertained through family studies of probands with and without attention-deficit/hyperactivity disorder (ADHD), yielding 58 adults with panic disorder and 587 who were free of major anxiety and mood disorders.

Results: The majority of referred (65%) and nonreferred (52%) adults with panic disorder had antecedent childhood anxiety or disruptive behavior disorders. Classification and Regression Trees (CART) analysis showed that both separation anxiety disorder and overanxious disorder were independent predictors of subsequent panic disorder in both referred and nonreferred samples.

Conclusions: These results confirm and extend previously reported findings by documenting that childhood anxiety disorders are important antecedent risk factors for panic disorder, independently of referral bias.
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http://dx.doi.org/10.1089/cap.2005.15.549DOI Listing
August 2005

Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder.

J Clin Psychiatry 2005 Feb;66(2):253-9

Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA 02114, USA.

Objective: To evaluate the effects of medications used in the treatment of adults with attention-deficit/hyperactivity disorder (ADHD) on blood pressure and pulse.

Method: Subjects were those with DSM-III-R-/DSM-IV-diagnosed ADHD enrolled in placebo-controlled studies of 5 different medications for ADHD. Cardiovascular data from these studies of both stimulants (methylphenidate, amphetamine compounds, pemoline) and nonstimulants (bupropion, desipramine) were reanalyzed for baseline-to-endpoint active-treatment or placebo effects on blood pressure and heart rate.

Results: There were 125 subjects with a mean +/- SD age of 39 +/- 9 years. In general, active drug treatment for ADHD compared to baseline was associated with several statistically significant changes in systolic blood pressure (bupropion: +5.9 mm Hg, p < .05 by paired t test; amphetamine: +5.4 mm Hg, p < .05), diastolic blood pressure (desipramine: +7.1 mm Hg, p < .05), and heart rate (bupropion: +6.9 mm Hg, p < .05; amphetamine: +7.3 mm Hg, p < .05; methylphenidate: +4.5 mm Hg, p < .05). New-onset cases of systolic or diastolic hypertension (blood pressure > or = 140/90) were recorded in 8% (7/89) of placebo-treated subjects and 10% (9/89) of subjects receiving active medication, regardless of the class (stimulant, nonstimulant).

Conclusion: Both stimulant and nonstimulant catecholaminergic medications used in adults with ADHD are associated with minor, but statistically significant, changes in heart rate and blood pressure that were often observed in those receiving placebo. Given the minor pressor and chronotropic effect of these medications, adults with ADHD should have their blood pressure and heart rate checked at baseline and periodically during treatment.
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http://dx.doi.org/10.4088/jcp.v66n0215DOI Listing
February 2005
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