Impact of Comorbid PTSD on Outcome of Repetitive Transcranial Magnetic Stimulation (TMS) for Veterans With Depression.

OBJECTIVE: A recent randomized controlled trial of repetitive transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) in veterans raised the question of whether comorbid posttraumatic stress disorder (PTSD) negatively impacted the outcome of TMS in veterans. To address this, a quality database was analyzed to compare outcomes of MDD treated with TMS in veterans with and without comorbid PTSD. METHODS: The clinical outcomes of all consecutive veterans with MDD treated with TMS at the James A. Haley Veterans' Hospital as outpatients from October 2013 through September 2018 were included. Patients were initially evaluated by an experienced psychiatrist, and the diagnosis of MDD was made by clinical evaluation per DSM-IV-TR/DSM-5 criteria. At the start of treatment, after every 5 treatments, and at the end of treatment, patients were assessed with self-report and clinician-rated scales of depression. All data were abstracted from an existing quality database. RESULTS: Among the 118 patients treated with TMS for depression, 55 (47%) had comorbid PTSD and 63 (53%) had no comorbid PTSD. Response and remission rates by score on the Montgomery-Asberg Depression Rating Scale were similar between patients with PTSD (52.5% and 40.9%, respectively) and without PTSD (53.8% and 35.6%, respectively). No seizures or persistent adverse effects were observed or reported in either group. CONCLUSIONS: Comorbid PTSD did not impact the outcome of TMS for depression in this sample of veterans. Future studies should include formal ratings of PTSD to determine if the severity of PTSD affects the outcome.

Exploring a Problem-Based Learning Approach in Pharmaceutics.

OBJECTIVE: The basis of this study was to explore the impact of the initiation of a Problem-Base Learning (PBL) approach within a second-year pharmaceutics degree on a Master of Pharmacy programme, introduced as a way of improving deep learning and to foster independent learning. DESIGN: A semi-structured interview was used to seek feedback from the students, and feedback from staff was secured though a focus group. A thematic approach was used for the analysis, once data saturation had been reached. Exam pass-rate statistics were also analysed. ASSESSMENT: Five parent themes were identified from the student interviews: Module structure, Promoting lifelong learning, Integration and future practice, Outcomes and Student experience. The third year exam pass rate improved by 12% in the year following the introduction of PBL in second year. CONCLUSIONS: Various recommendations were proposed to further improve the module, based on the findings of this study. These include improving feedback and support through tutorials, reducing the volume of directed study, as well as highlighting the relevance of pharmaceutics to the pharmacy degree. A long-term review would be needed to assess the full implications of PBL teaching within this course.

Preformulation of cysteamine gels for treatment of the ophthalmic complications in cystinosis.

Nephropathic cystinosis is a rare autosomal recessive disease characterised by raised lysosomal levels of cystine in the cells of all organs. It is treated by regular administration of the aminothiol, cysteamine. Corneal crystal deposition is one of the most troublesome complications affecting patients and requires the hourly administration of cysteamine eye drops. In an attempt to reduce this frequency and improve the treatment, the preformulation and evaluation of cysteamine containing gels is reported. Suitability for ophthalmic delivery was determined by analysis of rheology, bioadhesion, dissolution and stability. The results demonstrated that three polymers were suitable for ophthalmic delivery of cysteamine; namely sodium hyaluronate, hydroxyethyl cellulose and carbomer 934. Sodium hyaluronate displayed optimum performance in the preformulation tests, being pseudoplastic (reduction in apparent viscosity under increasing shear rate), bioadhesive, releasing cysteamine over 40min and displaying stability over time. In conclusion these results offer the possibility to formulate cysteamine in an ocular applicable gel formulation.

The hen's egg chorioallantoic membrane (HET-CAM) test to predict the ophthalmic irritation potential of a cysteamine-containing gel: Quantification using Photoshop® and ImageJ.

A modified hen's egg chorioallantoic membrane (HET-CAM) test has been developed, combining ImageJ analysis with Adobe(®) Photoshop(®). The irritation potential of an ophthalmic medicine can be quantified using this method, by monitoring damage to blood vessels. The evaluation of cysteamine containing hyaluronate gel is reported. The results demonstrated that the novel gel formulation is non-irritant to the ocular tissues, in line with saline solution (negative control). In conclusion, the modification of the established HET-CAM test can quantify the damage to minute blood vessels. These results offer the possibility to formulate cysteamine in an ocular applicable gel formulation.

The Concept of Missing Incidents in Persons with Dementia.

Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model. Examining the evidence base, specific factors within each category of the model were further described, reviewed and modified until consensus was reached regarding the final model. The model begins to explain in particular the variety of antecedents that are related to missing incidents. The model presented in this paper is designed to be heuristic and may be used to stimulate discussion and the development of effective preventative and response strategies for missing incidents among persons with dementia.

Safe home program: a suite of technologies to support extended home care of persons with dementia.

OBJECTIVE: To report the implementation/adoption of the Safe Home Program to support caregivers of persons with dementia in (1) ongoing surveillance, (2) provision of care, (3) prevention of injuries, and (4) improving home safety. METHODS: For this demonstration project 4 assessment questionnaires (Safety Assessment Scale, Vigilance Scale, Peace of Mind Scale, and Sleep Disorders Inventory) were administered to each dyad to understand their technological needs. After identification and installation of appropriate technologies and education of the caregiver, a final visit (at 3 months) determined whether technologies were useful and being used. RESULTS: The majority of caregivers utilized technologies for ongoing surveillance; other technologies included an identification program and medication organizer. CONCLUSION: Technologies focused on ongoing surveillance for persons with dementia at the home are needed. These technologies could be quickly adopted by caregivers to ameliorate some of the stress and burden associated with providing care for persons with dementia.

Prevalence of and antecedents to dementia-related missing incidents in the community.

OBJECTIVE: The primary aim of this study is to examine the prevalence of and antecedents to missing incidents among community-dwelling persons with dementia. METHODS: This prospective study used mailed surveys and telephone interviews. RESULTS: The prevalence of having any incident was 0.46/year; the overall prevalence for missing incidents in this study was 0.65/year. Missing incidents had few antecedents and occurred largely when persons with dementia were performing everyday activities that they normally completed without incident. CONCLUSION: Given that a missing incident is relatively common among persons with dementia, health care professionals should assist caregivers with a missing incident plan early in the disease process. Also, as missing persons are found by persons other than the caregiver and caregivers underutilize identification devices, health care professionals may recommend the use of identification devices to facilitate a safe return.

Expanding participation in Alzheimer's association Safe Return by improving enrollment.

Every adult with a diagnosis of progressive dementia is at risk for wandering away or becoming lost. Those with dementia may not have the capacity to remember crucial contact information or recognize an unsafe situation, so enrollment in a program like Alzheimer's Association Safe Return is crucial. One facility-level enrollment plan at the James A. Haley Veterans Hospital in Florida has had a relatively high participation rate. A mailed survey was used to help evaluate that enrollment process and the results are described here. Of 262 respondents to the survey, 193 (74%) indicated the person with dementia enrolled in Safe Return. Potential enrollees need the following facilitators: perception of an unsafe situation, financial support and easy processing. Safe Return is not just focused on those who wander but is essential for all persons with dementia as these individuals can become lost in the course of normal daily activities.