Decision aid development and its acceptability among adults with attention-deficit/hyperactivity disorders regarding treatment discontinuation after remission.

Aim: Current clinical guidelines for attention-deficit/hyperactivity disorder (ADHD) put shared decision making (SDM) at the center of care. However, there remain challenges in SDM in ADHD management, particularly regarding the decision to continue or discontinue medication after ADHD remission in adult patients. We aimed to develop a decision aid (DA) for adult patients with ADHD regarding the continuation or discontinuation of their ongoing ADHD medications after they have attained remission. Method: We systematically developed a DA according to the International Patient Decision Aid Standard (IPDAS). First, we created a DA prototype using the results of our previous systematic review and meta-analysis that identified the consequences of continuing and discontinuing ADHD medications. Second, we administered a mixed-method questionnaire (alpha acceptability testing) to adult patients with ADHD and healthcare providers to improve the DA prototype and develop it into a final version that is acceptable for clinical settings. Results: Our DA consisted of ADHD description, the option to continue or discontinue ADHD medications, the advantages and disadvantages of the consequences, as well as value clarification exercises for each option. Patients (n = 20) reported that the DA had acceptable language (85%), adequate information (75%), and a well-balanced presentation (53%). Healthcare providers (n = 19) provided favorable feedback. The final DA met all six IPDAS requisite criteria. Conclusions: Our results could facilitate the SDM process between patients and healthcare providers on the continuation or discontinuation of ADHD medication following remission. Further studies should verify the effects of using the DA during the SDM process among patients across the age spectrum with ADHD and healthcare providers.

Effect of Continuing and Discontinuing Medications on Quality of Life After Symptomatic Remission in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aimed to compare the effect of continuing and discontinuing medications on quality of life of patients with attention-deficit/hyperactivity disorder (ADHD). DATA SOURCES: PubMed, Cochrane Library, and Embase databases were searched using generic terms for ADHD, discontinuing, continuing, pharmacotherapy, and randomized controlled trials without date or language restrictions. STUDY SELECTION: Of the 3,672 screened studies, 9 met the predefined inclusion criteria on patients with ADHD; 5 of these 9 studies reporting on 1,463 patients (children and adolescents, n = 894; adults, n = 569) measured quality of life and were included in this meta-analysis. Only randomized, double-blind, placebo-controlled withdrawal trials of ADHD medications were included. DATA EXTRACTION: Data were independently extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. Analyses were based on random-effects models. RESULTS: Compared with continuing medications, discontinuing them significantly worsened quality of life score in patients with ADHD (standardized mean difference [SMD] = 0.19; 95% CI, 0.08 to 0.30]). Moreover, discontinuing medications worsened this score in children and adolescents with ADHD (SMD = 0.21; 95% CI, 0.06 to 0.36) but not in adults with ADHD (SMD = 0.02; 95% CI, -0.46 to 0.50). CONCLUSIONS: Discontinuing medications was associated with a small but statistically significant decrease in quality of life among children and adolescents with ADHD but not in adults with ADHD. Quality of life can be applied in pharmacologic interventions regarding continuing and discontinuing medication because this concept is related to individuals' appraisal of their situation. Quality of life is an important factor for planning individualized ADHD medication treatment.

Behavioral change of pharmacists by online evidence-based medicine-style education programs.

Background: Although e-learning evidence-based medicine (EBM) courses have proven useful in improving the knowledge and skills of residents, it was still unclear for pharmacists in non-English-speaking countries. Thus, we investigated the behavioral change of Japanese pharmacists who participated in an EBM-style e-learning educational program available online. Methods: This EBM-style e-learning program, the Japanese Journal Club for Clinical Pharmacists, was operated by three pharmacists through Skype. It comprised an online questionnaire administered to the program viewers. Two frequencies, the opportunity to be aware of EBM practices and that of reading an article, were compared before and after viewing the broadcast. Frequencies were classified into five categories: "almost every day," "1-2 times a week," "1-2 times a month," "1-2 times a year," and "not at all." The changes before and after viewing the broadcast were evaluated using a Wilcoxon signed-rank test. Results: The announcement of the questionnaire survey on the web was conducted during the journal club on August 24 and September 7, 2014. The maximum number of simultaneous audiences at the time was 113 persons. Among them, we analyzed data from 36 people who answered the questionnaire. Among these, "1-2 times a week" and "almost every day" were increased, whereas "not at all" was greatly reduced. Indeed, a significant difference was observed in overall change of each frequency before and after viewing the broadcast (P<.001). Conclusion: EBM-style learning programs may play an important role in the postgraduate clinical education of pharmacists.

Identification of sucrose diesters of aryldihydronaphthalene-type lignans from Trigonotis peduncularis and the nature of their fluorescence.

Phytochemical investigation of Trigonotis peduncularis resulted in the isolation of three aryldihydronaphthalene-type lignan sucrose diesters named trigonotins A-C (1-3). These lignans showed a strong yellow-green fluorescence emission under basic conditions. The structures of the new compounds were elucidated by means of spectroscopic methods, and the nature of their fluorescence was examined.

Tricin from a malagasy connaraceous plant with potent antihistaminic activity.

The bioassay-guided separation of a Malagasy plant, Agelaea pentagyna, led to the isolation of a flavonoid, tricin (1), with potent inhibitory activity toward exocytosis from antigen-stimulated rat leukemia basophils (RBL-2H3). The structure-activity relationships among structurally related natural and synthetic flavonoids are also discussed.