ObjectivesTo examine potentially inappropriate medication (PIM) use in older adults initiating an antimuscarinic medication for the treatment of overactive bladder (OAB).DesignRetrospective database analysis.SettingMedical and pharmacy claims data.ParticipantsMedicare Advantage Prescription Drug Plan members aged 65 and older newly initiated on an antimuscarinic OAB treatment were identified and assigned to PIM and non-PIM comparison groups based on 2012 American Geriatrics Society Beers Criteria and/or the presence of an anticholinergic medication interaction at the time of initiation of treatment (N = 66,275).MeasurementsHealthcare costs and OAB medication use.ResultsOf members initiated on an antimuscarinic OAB medication, 31.1% had a drug-drug or drug-disease or syndrome interaction. Dementia was the most common disease or syndrome interaction (11.3%), followed by constipation (8.6%) and delirium (2.9%). Paroxetine (2.6%), amitriptyline (2.2%), cyclobenzaprine (1.7%), and meclizine (1.6%) were the most common interacting medications. Subjects in the PIM group had greater healthcare costs over 12 months of follow-up ($12,001) than those in the non-PIM group ($9,373) after controlling for baseline characteristics (P < .001). There was no difference between the PIM and the non-PIM groups in odds of discontinuing OAB treatment at 12 months after controlling for baseline characteristics (odds ratio = 0.98, 95% confidence interval = 0.89-1.07, P = .63).ConclusionPotentially inappropriate medication use was highly prevalent and was associated with greater total healthcare costs. Providers should carefully consider medical history and concurrent medication use when initiating antimuscarinic medication for the treatment of OAB. Development of interventions to reduce potentially inappropriate use of antimuscarinics in individuals with OAB is warranted.

This study investigated the clinical effectiveness and cost-effectiveness of treatments for moderate to severe psoriasis from a managed health care systems perspective. An analysis was conducted of randomized clinical trials evaluating biologic and oral systemic medications and phototherapy for patients with moderate to severe psoriasis.

Obsessive–compulsive disorder (OCD) is a debilitating disorder for which the cause is not known and treatment options are modestly beneficial. A hypothesis is presented wherein the root cause of OCD is proposed to be a dysfunction of the gut microbiome constituency resulting in a susceptibility to obsessional thinking. Both stress and antibiotics are proposed as mechanisms by which gut microbiota are altered preceding the onset of OCD symptomology. In this light, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) leading to episodic OCD is explained not by group A beta-hemolytic streptococcal infections, but rather by prophylactic antibiotics that are administered as treatment. Further, stressful life events known to trigger OCD, such as pregnancy, are recast to show the possibility of altering gut microbiota prior to onset of OCD symptoms. Suggested treatment for OCD would be the directed, specie-specific (re)introduction of beneficial bacteria modifying the gut microbiome, thereby ameliorating OCD symptoms. Special considerations should be contemplated when considering efficacy of treatment, particularly the unhealthy coping strategies often observed in patients with chronic OCD that may need addressing in conjunction with microbiome remediation.

BACKGROUND:In the development of an antimelanoma vaccine, a critical factor is the identification of antigens that induce a strong immune response in humans and that are expressed by melanoma cells in vivo. The aim of this study was to identify candidate antigens for such vaccine.METHODS:Sixty-nine patients with surgically resected melanomas (American Joint Commission on Cancer [AJCC] stage III) were immunized with a polyvalent vaccine containing multiple melanoma antigens. Antimelanoma antibodies generated in the patients' sera were used as probes to identify the melanoma antigens that are immunogenic in humans and that are expressed on the tumor tissue in vivo. Such responses were determined by an immunoblotting assay that employed an antigen source prepared from membrane fractions of freshly excised melanoma tissue.RESULTS AND CONCLUSIONS:Vaccine treatment stimulated antibody responses in 35 (51%; 95% confidence interval [CI] = 39%-63%) of 69 sequentially enrolled patients. The antibodies were directed to one or more antigens with molecular masses of 45, 59, 68, 79, 89, 95, and/or 110 kd. The most immunogenic antigens were p110 and p68, which induced responses in 33% (95% CI = 22%-44%) and 25% (95% CI = 15%-35%) of patients, respectively. Both antigens were commonly expressed on different melanomas, but they were absent on autologous normal tissue and on an unrelated allogeneic tumor. All the above antigens are attractive candidates for vaccine construction.

98 children with cancer and 7 children with other serious hematologic or oncologic illnesses and their families are counselled by psychologists in close teamwork with pediatric oncologists within the framework of a clinical pilot study in 1982. The problems and questions of interest posed on the psychologists in 646 such contacts are classified and presented according to frequency of problems and contacts. The resulting large number and variety of concerns demonstrates that in addition to the direct illness- and treatment-related coping strategies (52 %) and related social/economic questions (30 %), a considerable portion of the problems can be classified within the realm of the clinical psychologist: behavioral disorders (37 %), family problems (33 %), late effects (26 %).

98 children with cancer and 7 children with other serious hematologic or oncologic illnesses and their families are counselled by psychologists in close teamwork with pediatric oncologists within the framework of a clinical pilot study in 1982. The problems and questions of interest posed on the psychologists in 646 such contacts are classified and presented according to frequency of problems and contacts. The resulting large number and variety of concerns demonstrates that in addition to the direct illness- and treatment-related coping strategies (52 %) and related social/economic questions (30 %), a considerable portion of the problems can be classified within the realm of the clinical psychologist: behavioral disorders (37 %), family problems (33 %), late effects (26 %).

The development and trial of a model care program carried out by psychologists in close collaboration with oncologists aimed at the comprehensive in- and off-ward care of children with cancer and their families is reported. A structured psychosocial anamnesis in interview-form ("Aufnahmebogen") and an information list ("Checkliste") are used shortly after diagnosis to identify problems and to systematically inform on psychosocial support schemes. The procedure allows a comprehensive, early and preventative psychosocial care. An evaluation of 646 carefully documented contacts was carried out according to the criteria: number of contacts, initiator, person contacted, reason for contact and function of the psychologist. Various prerequisites important for the integration of psychologists into the oncological team are specified and discussed.

We report on 3 cases of male late-adolescent/young-adult osteogenic sarcoma patients who refused complete chemical therapy according to the treatment plan "COSS 80". They all originated from disturbed family situations. Characteristic was their early independence and autonomy, dominance tendency, low level of self control, and high level of sociability. Primary motivation for refusal was the experienced intolerability of the chemotherapeutical side-effects and extreme fear of medical procedures (e.g. injections).

We report on 3 cases of male late-adolescent/young-adult osteogenic sarcoma patients who refused complete chemical therapy according to the treatment plan "COSS 80". They all originated from disturbed family situations. Characteristic was their early independence and autonomy, dominance tendency, low level of self control, and high level of sociability. Primary motivation for refusal was the experienced intolerability of the chemotherapeutical side-effects and extreme fear of medical procedures (e.g. injections).