F.Y.Eye
1
824 CAN J OPHTHALMOL—VOL. 41, NO. 6, 2006 F. Y. EYE F. Y. Eye presents summaries of publications and news stories of interest to ophthalmologists. If you have suggestions or contributions, please send them to Ian McIlraith at [email protected]. Ketamine found to be a rapid onset treatment for treating depression Traditional drugs used in the treatment of depres- sion have an onset of action of several weeks. This lag period can result in increased risk of suicidal behav- iour and morbidity while waiting for the drugs to take effect. The search for drugs with a faster onset led to investigations of N-methyl-D-aspartate receptor antagonists. Researchers conducted a randomized, placebo-controlled, double-blind crossover study of ketamine on 18 patients suffering treatment-resistant major depression. There was a significant improve- ment in depression in patients who received 0.5 mg/kg ketamine compared with subjects receiving placebo within 110 minutes after injection. This effect remained significant throughout the following week. One day after ketamine infusion, 71% of patients met response criteria and 29% met remission criteria. Zarate CA Jr, Singh JB, Carlson PJ, et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 2006;63:856–64. Deep-brain stimulation for Parkinson’s disease more effective than medications alone Parkinson’s disease causes major morbidity, but drug treatments not only result in significant movement- related side effects but also lose effectiveness over time. Deep-brain stimulation (the administration of high- frequency continuous electrical stimulation to the subthalamic nucleus through a surgically implanted device) has been demonstrated to improve motor symptoms in patients with advanced stages of Parkinson’s disease, but only in individual patients and case series. Researchers in the German Parkinson Study Group conducted a randomized trial of deep- brain stimulation on 156 patients with advanced Parkinson’s disease, comparing the outcome of deep- brain stimulation plus medication to medication alone. It was found that neurostimulation resulted in significant improvements in mobility, activities of daily living, emotional status, and discomfort at 6 months compared with medication alone. Serious adverse events were more common, however, in the group undergoing deep-brain stimulation (13% vs. 4%), with one fatality directly related to the surgical inter- vention. Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006;355:896–908. Pain not necessarily associated with changes in vital signs It is commonly assumed that pain results in changes in vital signs, but that may not necessarily be true. Researchers conducted a retrospective, observa- tional study of patients in the emergency department to look at associations between self-reported pain and vital signs (heart rate, blood pressure, or respiratory rate). Over the course of one year, 1063 patients with conditions known to be painful (e.g., nephrolithiasis, myocardial infarction, fractures, amputations, corneal abrasions) were included. The researchers found no association between the pain scores reported at triage and the patients’ heart rate, blood pressure, or respiratory rate. Marco CA, Plewa MC, Buderer N, Hymel G, Cooper J. Self- reported pain scores in the emergency department: lack of association with vital signs. Acad Emerg Med 2006;13:974–9. β-Blocker use still high in patients with respira- tory disease Topical β-blocker use for glaucoma is contraindi- cated in patients with obstructive pulmonary disease (OPD). Researchers in Israel looked at whether the existence of a central electronic medical record (EMR), which included patient information from the primary care physician, reduced the inappropriate use of topical β-blockers in patients with OPD. They sur- veyed 7481 patients who were prescribed topical antiglaucoma medications, of whom 14.5% were diagnosed with OPD. Overall, patients with OPD were prescribed topical β-blockers 61.8% of the time compared with 72.1% of patients without OPD. For OPD patients with an EMR, the rate of β-blocker use was 59.5% versus 66.4% for patients without an EMR (p = 0.06). The authors concluded that although the existence of an EMR reduced the rate of β- blocker use in patients with OPD, the rate was still unacceptably high. Vinker S, Kaiserman I, Waitman DA, Blackman S, Kitai E. Prescription of ocular β-blockers in patients with obstructive pulmonary disease: does a central electronic medical record make a difference? Clin Drug Invest 2006;26:495–500.
Transcript of F.Y.Eye
824 CAN J OPHTHALMOL—VOL. 41, NO. 6, 2006
F.Y. EYE
F. Y. Eye presents summaries of publications and news storiesof interest to ophthalmologists. If you have suggestions orcontributions, please send them to Ian McIlraith at [email protected].
Ketamine found to be a rapid onset treatmentfor treating depression
Traditional drugs used in the treatment of depres-sion have an onset of action of several weeks. This lagperiod can result in increased risk of suicidal behav-iour and morbidity while waiting for the drugs to takeeffect. The search for drugs with a faster onset led toinvestigations of N-methyl-D-aspartate receptorantagonists. Researchers conducted a randomized,placebo-controlled, double-blind crossover study ofketamine on 18 patients suffering treatment-resistantmajor depression. There was a significant improve-ment in depression in patients who received 0.5mg/kg ketamine compared with subjects receivingplacebo within 110 minutes after injection. This effectremained significant throughout the following week.One day after ketamine infusion, 71% of patients metresponse criteria and 29% met remission criteria.Zarate CA Jr, Singh JB, Carlson PJ, et al. A randomized trial of an
N-methyl-D-aspartate antagonist in treatment-resistantmajor depression. Arch Gen Psychiatry 2006;63:856–64.
Deep-brain stimulation for Parkinson’s diseasemore effective than medications alone
Parkinson’s disease causes major morbidity, but drugtreatments not only result in significant movement-related side effects but also lose effectiveness over time.Deep-brain stimulation (the administration of high-frequency continuous electrical stimulation to thesubthalamic nucleus through a surgically implanteddevice) has been demonstrated to improve motorsymptoms in patients with advanced stages ofParkinson’s disease, but only in individual patients andcase series. Researchers in the German ParkinsonStudy Group conducted a randomized trial of deep-brain stimulation on 156 patients with advancedParkinson’s disease, comparing the outcome of deep-brain stimulation plus medication to medicationalone. It was found that neurostimulation resulted insignificant improvements in mobility, activities of dailyliving, emotional status, and discomfort at 6 monthscompared with medication alone. Serious adverseevents were more common, however, in the groupundergoing deep-brain stimulation (13% vs. 4%),
with one fatality directly related to the surgical inter-vention.Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial
of deep-brain stimulation for Parkinson’s disease. N Engl JMed 2006;355:896–908.
Pain not necessarily associated with changes invital signs
It is commonly assumed that pain results inchanges in vital signs, but that may not necessarily betrue. Researchers conducted a retrospective, observa-tional study of patients in the emergency departmentto look at associations between self-reported pain andvital signs (heart rate, blood pressure, or respiratoryrate). Over the course of one year, 1063 patients withconditions known to be painful (e.g., nephrolithiasis,myocardial infarction, fractures, amputations,corneal abrasions) were included. The researchersfound no association between the pain scoresreported at triage and the patients’ heart rate, bloodpressure, or respiratory rate.Marco CA, Plewa MC, Buderer N, Hymel G, Cooper J. Self-
reported pain scores in the emergency department: lack ofassociation with vital signs. Acad Emerg Med 2006;13:974–9.
β-Blocker use still high in patients with respira-tory disease
Topical β-blocker use for glaucoma is contraindi-cated in patients with obstructive pulmonary disease(OPD). Researchers in Israel looked at whether theexistence of a central electronic medical record(EMR), which included patient information from theprimary care physician, reduced the inappropriate useof topical β-blockers in patients with OPD. They sur-veyed 7481 patients who were prescribed topicalantiglaucoma medications, of whom 14.5% werediagnosed with OPD. Overall, patients with OPDwere prescribed topical β-blockers 61.8% of the timecompared with 72.1% of patients without OPD. ForOPD patients with an EMR, the rate of β-blocker usewas 59.5% versus 66.4% for patients without anEMR (p = 0.06). The authors concluded that althoughthe existence of an EMR reduced the rate of β-blocker use in patients with OPD, the rate was stillunacceptably high.Vinker S, Kaiserman I, Waitman DA, Blackman S, Kitai E.
Prescription of ocular β-blockers in patients with obstructivepulmonary disease: does a central electronic medical recordmake a difference? Clin Drug Invest 2006;26:495–500.
