Repeat Courses Research Articles

APA 168th Annual Meeting Course Guide

Back to table of contents Next article Annual MeetingFull AccessAPA 168th Annual Meeting Course GuideCathy CroneM.D.Cathy CroneSearch for more papers by this authorM.D.Published Online:1 Apr 2015https://doi.org/10.1176/appi.pn.2015.1b55You might ask yourself, “Why take a course at the APA annual meeting?” Whether you wish to prepare for certification exams, enhance your clinical skills, or remain abreast of exciting uses of technology and research advances in psychiatry, the APA Subcommittee on Courses has planned something for you!Over the years, exceptional continuing medical education courses have become a tradition at APA’s annual meeting. Courses are offered in half-day (four hours) and full-day (six or eight hours) formats. This year’s courses encompass new offerings, highly evaluated repeat courses directed by national and international experts, and improved versions of courses given in the past. We will be covering a wide variety of topics this year, including depressive disorders, addiction psychiatry, geriatric psychiatry, integrated care, and psychopharmacology.In addition to me, serving on the Subcommittee on Courses are my vice chair, Linda Worley, and committee members Anna Dickerman, M.D., Steve Koh, M.D., Michael Myers, M.D., Arnold Moreno, M.D., and Charles Price, M.D. Along with Tiffany Burns, conference CME program manager, we have worked hard to evaluate course submissions critically to provide an exceptional, in-depth educational experience for all. The Subcommittee on Courses limits course enrollment size to maximize opportunities for participant-faculty interaction. To secure your place in a course, register early! The courses sell out quickly. Registration and enrollment information and forms can be accessed at APA’s website. Online meeting and housing registration can also be accessed from this site.All mailed and faxed registration and pre-enrollment forms must be received at APA on or before April 17. After this date, on-site fees are in effect for meeting and course registration. The course enrollment area is located in the Toronto Convention Centre and the Sheraton Centre. Only those who have registered for the annual meeting may purchase course tickets.See you there!Click here to view the APA 168th Annual Meeting Course Guide.■ ISSUES NewArchived

Antenatal corticosteroids for preterm premature rupture of membranes: single or repeat course?

The aim of this article is to determine the risk of maternal chorioamnionitis and neonatal morbidity in women with preterm premature rupture of membranes (PPROM) exposed to one corticosteroid course versus a single repeat corticosteroid steroid course. Secondary analysis of a cohort of women with singleton pregnancies and PPROM. The primary outcome was a clinical diagnosis of maternal chorioamnionitis. Using multivariate logistic regression, we controlled for maternal age, race, body mass index, diabetes, gestational age at membrane rupture, preterm labor, and antibiotic administration. Neonatal morbidities were compared between groups controlling for gestational age at delivery. Of 1,652 women with PPROM, 1,507 women received one corticosteroid course and 145 women received a repeat corticosteroid course. The incidence of chorioamnionitis was similar between groups (single course = 12.3% vs. repeat course = 11.0%; p = 0.8). Women receiving a repeat corticosteroid course were not at increased risk of chorioamnionitis (adjusted odds ratio, 1.28; 95% confidence interval, 0.69-2.14). A repeat course of steroids was not associated with an increased risk of any neonatal morbidity. Compared with a single steroid course, our findings suggest that the risk of maternal chorioamnionitis or neonatal morbidity may not be increased for women with PPROM receiving a repeat corticosteroid course.

Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids

To investigate the efficacy and safety of repeated 12-week courses of 5 or 10 mg daily of ulipristal acetate for intermittent treatment of symptomatic uterine fibroids. Double-blind, randomized administration of two 12-week courses of ulipristal acetate. Gynecology centers. A total of 451 patients with symptomatic uterine fibroid(s) and heavy bleeding. Two repeated 12-week treatment courses of daily 5 or 10 mg of ulipristal acetate. Amenorrhea, controlled bleeding, fibroid volume, quality of life (QoL), pain. In the 5- and 10-mg treatment groups (62% and 73% of patients, respectively) achieved amenorrhea during both treatment courses. Proportions of patients achieving controlled bleeding during two treatment courses were >80%. Menstruation resumed after each treatment course and was diminished compared with baseline. After the second treatment course, median reductions from baseline in fibroid volume were 54% and 58% for the patients receiving 5 and 10 mg of ulipristal acetate, respectively. Pain and QoL improved in both groups. Ulipristal acetate was well tolerated with less than 5% of patients discontinuing treatment due to adverse events. Repeated 12-week courses of daily oral ulipristal acetate (5 and 10 mg) effectively control bleeding and pain, reduce fibroid volume, and restore QoL in patients with symptomatic fibroids. NCT01629563 (PEARL IV).

648: Single vs repeat courses of antenatal corticosteroids with twin gestations

648: Single vs repeat courses of antenatal corticosteroids with twin gestations

Repeat Course of Rabbit Antithymocyte Globulin As Salvage Following Initial Therapy with Rabbit Antithymocyte Globulin in Acquired Aplastic Anemia

In patients with severe acquired aplastic anemia (AA) not eligible for hematopoietic stem cell transplant (HSCT), immunosuppression with horse antithymocyte globulin (h-ATG) and cyclosporine (CsA) is standard and is associated with a high response rate of about 60-70% at 6 months (Scheinberg et al. N Engl J Med 365: 430, 2011). Patients who are unresponsive to initial h-ATG can be rescued with rabbit ATG (r-ATG) in a third of cases (Scheinberg et al. Br J Haematol 133: 622, 2006). Since 2007, h-ATG is no longer available in most Latin American, Asian and European countries, with rabbit ATG (r-ATG) the only ATG formulation available in these markets. However, the outcome with r-ATG as first therapy in SAA is significantly inferior to that of h-ATG with worst response rate and overall survival (Scheinberg et al. N Engl J Med 365: 430, 2011). The salvage rate for patients who failed initial r-ATG is low with alemtuzumab and horse ATG [Scheinberg et al. Blood 119: 345, 2012; Am J Hematol 89: 467, 2014]. However, the salvage rate of a repeat course of r-ATG after initial r-ATG is unknown. Thus, we conducted a retrospective analysis in marrow failure referral Brazilian and Argentinian centers to address this question. The primary endpoint was hematologic response at 3 and 6 months, which was defined as transfusional independence and no longer meeting criteria for severe AA. Secondary endpoints included relapse, clonal evolution, and overall survival. Since 2005, 37 patients (32 refractory and 5 relapsed; 57% males, median age, 17 years; range 3-63 years) were re-treated with r-ATG (Thymoglobuline¨, Genzyme, Cambridge, MA, USA) with median dose of 3.5 mg/kg/d (range 1.67-5.0) for 5 days and oral cyclosporine adjusted to maintain blood levels between 150 and 400 ng/mL for 6 months. Corticosteroids, usually methylprednisolone, were given for at least 2 weeks to prevent serum sickness and trimethoprim–sulfamethoxazole was administered as Pneumocystis jiroveci prophylaxis. Only patients that completed the 5 day r-ATG course were included in the analysis. Second treatment was administered at a median of 283 days from first r-ATG/CsA (range 118-2379 days). After a median follow-up of 726 days (range 7-2320 days), the overall response rates at 3 and 6 months for initial r-ATG refractory patients was 5/32 (16%) and 7/32 (22%), respectively, and for those who relapsed 60% (3/5) (Table). Among all responders, 2 (20%) relapsed at 170 and 897 days after second treatment. In total, clonal evolutions were observed in 6 patients; 5 in non-responders (4 to monosomy 7; 1 trisomy 8 and 21), and 1 in a responder (myelodysplastic syndrome with normal karyotype). Three non-responders underwent matched-unrelated donor allogeneic HSCT. Twelve patients died, all who were non-responders to repeat r-ATG. Overall survival at 4.1 years (censored at the time of HSCT) was 58% (95% CI, 36-75%) (Figure). Our findings indicate that only a minority of r-ATG refractory AA patients may be successfully rescued with a second course of the same immunosuppression. Similar low salvage rates have been reported with alemtuzumab and h-ATG for those refractory to initial r-ATG. In the aggregate, these data show that: 1) other therapies should be considered for those refractory to initial r-ATG such as alternative donor HSCT, thrombopoietin agonists, or other experimental therapies; 2) the high success rate of initial h-ATG therapies cannot be recapitulated when r-ATG is administered first given the low salvage rate with alemtuzumab, h-ATG and now (current data) with r-ATG; 3) for patients that relapse after first r-ATG treatment, second course r-ATG may be a reasonable option.Table:Hematologic response at 3 and 6 months to second course of rabbit ATG plus cyclosporineRefractory to first r-ATG/CsA(n=32)95% CIRelapsed to first r-ATG/CsA(n=5)95% CIAt 3 months no. (%)5 (16)3-283 (60)17-100At 6 months no. (%)7 (22)8-363 (60)17-100 [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Rituximab with High Dose Methotrexate in the Management of Primary Central Nervous System Diffuse Large B-Cell Lymphoma

Introduction:Outcomes of patient with primary central nervous system lymphoma (PCNSL) remain poor despite high-dose methotrexate (HDMTX)-based chemotherapy regimens. The addition of rituximab (R) to chemotherapy improves response rates and outcomes in patients with systemic B-cell non-Hodgkin lymphomas. However, R does not penetrate the blood-brain barrier, and therefore its impact in patients with PCNSL is unknown. With disappointing outcomes, in 2006, we routinely started adding R to HDMTX for the treatment of PCNSL. Herein, we evaluated the outcome of patients receiving HDMTX with or without R.Methods:Patients diagnosed with PCNSL (DLBCL histology only) between January 2000 and December 2013, and who were treated with at least one cycle of HDMTX, were identified in the Lymphoid Cancer Database. Since January 2000, patients with PCNSL in British Columbia have been treated with HDMTX 8 g/m2 every 2 weeks, pro-rated for creatinine clearance. Responding patients received a maximum of 10 cycles. Beginning in December 2006, rituximab 375 mg/m2 is given every 2 weeks with HDMTX for a total of 4 doses. Progression free survival (PFS) was defined as the time interval from date of diagnosis to first evidence of progression/relapse, death or last follow-up. Overall survival (OS) was defined as the time interval from date of diagnosis to death or last follow-up.Results:A total of 82 patients were identified. Median age at diagnosis was 61years (range 18-80), 42 (51%) were >60 years old, 48 (59%) were male, 18 (23%) had elevated LDH and 50 (61%) had performance status > 1. Median largest mass size was 4cm (range 1-9). Concurrent ocular (7 patients), leptomeningeal (3 patients), and spinal cord (1 patient) involvements were seen.For treatment, 55 (67%) received HDMTX and 27 (33%) received HDMTX+R. Patients received a median of 4 (range 1-9) HDMTX cycles, with no difference between R versus no R groups. Ten (12%) patients (6 HDMTX, 4 HDMTX+R) received whole brain radiotherapy (RT), as part of initial treatment due to chemo-intolerance. In 79 patients evaluable for response, the overall response rate to initial treatment was 55%: CR 40%, PR 15%, SD 5%, and PD 41%. There were no significant differences in the baseline characteristics or response rates between the two groups.A total of 14/32 patients (44%) relapsed after CR (all in the brain, including 1 to the contralateral eye) and 8/12 (67%) relapsed after PR (7 in brain, 1 to bilateral eyes). At 1st relapse/progression (N = 56), 39 (69%) patients received RT, 4 received repeat courses of HDMTX, 2 received high dose chemotherapy/autologous stem cell transplantation (ASCT) and 1 received temozolamide + R. 10 patients were managed supportively. Four patients had a systemic relapse without involvement of the CNS (1 Breast, 1 testis, 1 axilla and 1 scalp). They received R-CHOP (3), CHOP then R-GDP and ASCT (1).After a median follow-up of 5 years (range 0.1 to 12.7) in living patients, the 5-year OS was 38% (SE 6%), with no difference between patients treated with or without R (HR 0.81, 95% CI 0.40, 1.63; p= 0.55). The 5-year PFS was 20% (SE 5%), again with no difference between the two groups (HR 0.84, 95% CI 0.47, 1.48; p= 0.54). In the subset of 50 patients receiving > 4 cycles of chemotherapy (34 HDMTX, 16 HDMTX+R), the addition of rituximab did not impact PFS (p= 0.36) or OS (p= 0.08). In the subset of 72 patients who did not receive WBRT as part of initial therapy (49 HDMTX, 23 HDMTX + R), the addition of rituximab did not impact PFS (p= 0.48) or OS (p= 0.47).Conclusions:Our preliminary data shows no advantage to the addition of systemic R on the outcomes of PCNSL, consistent with its known poor CNS penetrance. Improved treatment modalities for PCNSL are still warranted. [Display omitted] [Display omitted] DisclosuresShenkier:F Hoffmann-La Roche: Other. Connors:F Hoffmann-La Roche: Other. Gerrie:F Hoffmann-La Roche: Other. Klasa:F Hoffmann-La Roche: Other. Savage:F Hoffmann-La Roche: Other. Sehn:F Hoffmann-La Roche: Other. Villa:F Hoffmann-La Roche: Other.

246Frequency of Occurrence and Antimicrobial Susceptibility of Gram-negative Organisms Isolated from Health Care–Associated (HCA) Urinary Tract Infections (UTI) in the United States: Results from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS)

■ Urinary tract infections (UTIs) are among the most frequent healthcare-associated (HCA) infections. Escherichia coli is the most common UTI pathogen observed in both the community and healthcare settings. In recurrent UTI, and especially when structural abnormalities of the urinary tract are present, the relative frequency of Klebsiella spp., Proteus spp., Pseudomonas spp., and Enterobacter spp. increases. Antimicrobial-resistant isolates are common in these complicated UTIs (cUTIs) in which instrumentation and repeat courses of antimicrobial therapy are frequently used. ■ Antimicrobial-resistant strains that produce extended-spectrum β-lactamases (ESBLs) are prevalent among Enterobacteriaceae, predominantly E. coli and Klebsiella spp., and have become endemic in many hospitals. Pseudomonas aeruginosa also represents a major cause of UTI, and often demonstrates decreased susceptibility to various antimicrobial agents. INTRODUCTION RESULTS (cont’d)

Delayed Total Knee Replacement with Hylan G-F 20.

We retrospectively examined prospective data on the incidence and time to total knee replacement (TKR) in (1) patients with grade IV osteoarthritis (OA) treated with hylan G-F 20 from 1997 to 2010 (full cohort; 1,863 knees) and (2) a patient subset treated from 1997 to 2003 (original cohort; 1,187 knees) to determine any continued hylan G-F 20 influence on TKR delay. In both the cohorts, 25 to 28% knees underwent a TKR, with an average of 2.8 to 3.1 years occurring between hylan G-F 20 and surgery. Age was a significant predictor of time to TKR. Knee synovitis increased slightly with repeat courses; most cases considered mild or moderate. Survival analysis showed that TKR was delayed for > 7 years in 75% of 1,863 grade IV OA knees (1,342 patients) treated with hylan G-F 20 in an orthopedic practice. Consistent with our previous report (Waddell and Bricker, 2007), we show hylan G-F 20 continues to delay the need for TKR.

How the admission criteria to a competitive-entry undergraduate programme could be improved

The introduction of a new standards-based secondary school assessment system, the National Certificate of Educational Achievement (NCEA), necessitated significant changes to the admissions processes for New Zealand universities, particularly for competitive-entry programmes such as medicine, engineering and pharmacy. Selection to such programmes was traditionally based on marks or grades in designated science subjects. Under NCEA, the emphasis changed to the number of credits obtained. This article uses the case of pharmacy at The University of Auckland to examine whether the admission criteria under NCEA are ‘fit for purpose’ in terms of academic progression during the degree. The negative consequences of students having to repeat courses are both academic and financial. Using data from six cohorts of NCEA entrants to the Bachelor of Pharmacy (BPharm) degree, the findings of this study clearly suggest that the best predictor of course success, measured by not failing courses, is the NCEA Grade Point Average. This is at variance with the current practice for admission to pharmacy and other limited-entry degrees which rely on prerequisite courses and the number of NCEA Credits gained. These results suggest that a reappraisal of admissions processes for pharmacy and similar programmes is required.

Clinical outcomes of palliative radiation therapy for children

PurposeIn contrast to studies of adults, there are limited published data regarding palliative radiation therapy (RT) for children, and further study is greatly needed. Methods and materialsWe performed a retrospective review of all pediatric patients referred to our radiation oncology department over a 5-year span from January 1, 2007, to December 31, 2011. ResultsOf 244 total pediatric patients referred, a subset of 45 (18.4%) were treated specifically with palliative intent for a total of 83 courses of RT. Follow-up data until study closure or death were available for 98% of patients. The median survival after initiation of palliative RT was 6.5 months. Overall, 23% of the children were alive at last follow-up visit, and 77% were deceased. The prescribed RT was completed in 93% of courses; 7% of courses were discontinued because of clinical deterioration due to systemic disease progression. The overall symptom response rate (partial or complete) was 72%. Overall response rate by symptom was 80% for bone pain, 55% for dyspnea or chest pain, 58% for neurologic symptoms, 50% for bleeding, and 100% for liver pain or ascites. Response rates by histology were 100% for leukemias, 91% for neuroblastoma, 76% for Ewing sarcoma, 64% for rhabdomyosarcoma, 54% for osteosarcoma, and 50% for primary central nervous system neoplasms. For responders, the median time from RT initiation to response was 1 week. For 7% of patients, a repeat course of RT for the same site and symptom was performed. No patients experienced RTOG (Radiation Therapy Oncology Group) grade 3 or greater acute or late toxicities. ConclusionsRT is a useful palliative tool for pediatric patients that merits continued use and further study.

Acute phase plasma proteins are altered by electroconvulsive stimulation.

Electroconvulsive therapy (ECT) is an effective antidepressant treatment, but its molecular mechanisms of action remain to be fully elucidated. To better understand the effects of ECT, we conducted a proteomic study to characterize global changes in plasma protein abundance induced by electroconvulsive stimulation (ECS) in the animal model equivalent of ECT. Male Sprague-Dawley rats were administered a single or repeat (10 sessions) course of ECS, and compared with sham-ECS administered animals. Quantitative differential protein expression analysis was performed, using 2-dimensional difference in gel electrophoresis (2D DiGE), on immunodepleted plasma. Proteins were selected for identification by liquid chromatography tandem mass spectrometry (LC-MS/MS): 150 protein spots were significantly altered following a single ECS and 178, following repeated ECS. In total, 18 proteins were identified by LC-MS/MS. Many of these were acute-phase response proteins, previously reported to be increased in depressed patients. Changes in the abundance of two proteins of interest were confirmed by other measures. Repeat ECS was found to significantly reduce plasma levels of haptoglobin and apolipoprotein A-IV, although these changes were no longer evident 4 weeks after the repeated ECS. Our results implicate the immune system-induced acute phase protein response in ECS action while identifying potential plasma biomarkers for ECS.

The troubling inconsistencies within the medical educator role

At the time, I did not know why, but I was dreading this meeting. I was waiting for a first year medical student who had been five points below the minimum performance level (MPL) on the Course 1 summative examination (her first examination in medical school), had passed the summative examinations for Courses 2 and 3, but then scored 1.3% below MPL on the repeat Course 1 examination seven months later. I was meeting with her to discuss the procedure whereby I would present her case to the Student Academic Review Committee with the recommendation to repeat the first year. This procedure had been in place for many years, was clearly outlined in the Student Handbook, and met the procedural requirements for accreditation by the Liaison Committee for Medical Education (LCME). So what was my problem? Was I troubled by the fact that when interacting with medical students the ranking for ethical principles is quite different from how I relate to my patients? In the upcoming meeting, we were not planning to explore her perceptions of her learning needs and then tailor a remediation program to these. We had no intention of weighing the benefits of our recommendations against the financial implication of repeating her first year (and possibly working one year less postgraduation), or the trauma of having to form a new peer group and explain why to her former and future peer groups. And we were not about to discuss the fact that by forcing her to repeat her first year there would be one fewer new applicant to medical school this year and one fewer physician graduating two years from now. Instead, in our education practice, we follow the all-powerful principle of institutional policy, and my role during this meeting would be to explain this to her. Or perhaps I feared that she would ask for data on the predictive validity of our evaluation tools. What is the risk of her being an incompetent physician given her inability to achieve the MPL on Course 1? And by how much is this risk reduced if she repeats her first year? In our clinical practice, we teach students to use screening tests only if they can reliably predict meaningful outcomes, and to recommend treatment that has been shown to improve these outcomes. Our education practice requires us to have screening tests along with procedures for dealing with students who fail these tests. We are not actually obligated to demonstrate predictive validity of these tests or efficacy of our interventions (Woloschuk et al. 2010). Kohlberg’s (1973) theory of moral development recognizes three distinct levels of reasoning: pre-conventional, conventional, and post-conventional. In the pre-conventional level (which is typical of young children), decision makers are egocentric and are concerned with maximizing personal gain, e.g., in receiving rewards and avoiding punishment. The focus at the conventional level, which is achieved by most adults, is on conformity to social norms (or MPLs) and maintaining law and order. Adults who progress to the post-conventional level are capable of abstract moral reasoning and judge actions according to their own moral principles – even if these are at odds with social norms or regulations. In Kohlberg’s view, we progress invariably through these stages and at that any given level or moral reasoning we consistently take the same perspective across different areas of content (Kohlberg 1973). Kohlberg’s theory is still the dominant framework in the area of moral development, but others in this field have

Use of aprepitant in uncontrolled delayed nausea and vomiting associated with preparative regimens in stem cell transplantation: A retrospective analysis.

9613 Background: Aprepitant, a well tolerated antiemetic, is indicated for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic ch...

Evidence to support use of palonosetron over generic serotonin type 3–receptor antagonists for chemotherapy-induced nausea and vomiting

Palonosetron, a serotonin type 3–receptor (5-HT3) antagonist, was approved by the Food and Drug Administration (FDA) in 2003 for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) associated with initial and repeat courses of highly emetogenic chemotherapy (HEC) and moderately

Influencia relativa de variables metacognitivas y volitivas en el rendimiento académico de estudiantes de Bachillerato (LOE) = Relative influence of metacognitive and volitive variables in the academic achievement of baccalaureate students

RESUMEN En esta investigacion, dentro del marco general de la autorregulacion del aprendizaje, se ha intentado estudiar la influencia relativa que ciertas variables metacognitivas y volitivas ejercen sobre el rendimiento academico en alumnos/as de Bachillerato LOE (Ley Organica de Educacion, 2006). Tambien se analiza la fiabilidad y consistencia interna del LASSI, Inventario de Estrategias de Estudio y Aprendizaje de Weinstein (1987) y del AVSI (Inventario de Estrategias Volitivas Academicas, de McCann y Turner, 2004), en una muestra de 113 estudiantes, cuyas edades oscilan entre los 16 y los 20 anos. Se diseno un cuestionario “ad hoc” con cuatro categorias de respuesta excluyentes en las que se auto-ubicaba el alumno/a en funcion de su gestion del tiempo de estudio. Se estudian y analizan las diferencias significativas encontradas en rendimiento academico final en funcion de la modalidad elegida (Ciencias versus Letras), del manejo del tiempo, de las variables volitivas y de aprendizaje, principalmente metacognitivas, del curso (1o o 2o), del sexo y de ser o no repetidor, encontrando resultados que van a favor de los estudiantes de Ciencias, las mujeres y el no ser repetidor. Solamente un 12% de estudiantes gestionan bien su tiempo, al 37% le falta tiempo, y un 51% no lo maneja bien, y ademas le falta tiempo. Se han encontrado predictores del rendimiento academico final, como la preparacion de examenes y la motivacion y caracteristicas asociadas a alumnos con tres niveles del rendimiento (alto, medio y bajo) en las variables independientes principales. ABSTRACT This investigation was carried out with a group of one hundred and thirteen baccalaurate students (fifty three men and sixty women, in one Secondary Education Institute in Zaragoza (Spain). It intends to analyse the relative influence that some metacognitive and volitive variables exert over the academic achievement. We also intended to know the reliability and internal consistence of the LASSI –Learning and Study Strategies Inventory- (Weinstein, 1987), and the AVSI (McCann & Turner, 2004) in Spanish samples (16-20 years old). Final achievement was found to bebetter in Sciences students, women, and students who did not repeat course. The characteristics of the students that manage correctlytheir academic study time have been identified, through an “ad hoc” questionnaire with four nominal categories. 12% of students managed their study time well and improved it; the 37% believed to manage it correctly but they need more time; and 51% do not manage their own study time well, and also need more time. The final achievement differences have been found between these four groups, with a higher GPA (grade point average) in the first and second groups. The motivation and test strategies variables are the best predictors of the final achievement. No differences were found between men and women in the GPA, but women scored higher in the Study Aids, Self-Testing, Self-Efficacy Enhancement, and total AVSI subscales.

APA 167th Annual Meeting Course Guide

Back to table of contents Previous article Next article APA NewsFull AccessAPA 167th Annual Meeting Course GuideCathy Crone, M.D.Cathy CroneSearch for more papers by this author, M.D.Published Online:17 Jan 2014https://doi.org/10.1176/appi.pn.2014.1b40You might ask yourself, “Why take a course at the APA annual meeting?” Whether you wish to prepare for certification exams, enhance your clinical skills, or remain abreast of exciting uses of technology and research advances in psychiatry, the APA Subcommittee on Courses has planned something for you!Over the years, exceptional continuing medical education courses have become a tradition at APA’s annual meeting. Courses are offered in half-day (four hours) and full-day (six or eight hours) formats. This year’s courses encompass new offerings, highly evaluated repeat courses directed by national and international experts, and improved versions of courses given in the past. We will be covering a wide variety of topics this year, including depressive disorders, addiction psychiatry, geriatric psychiatry, integrated care, and psychopharmacology.In addition to me, serving on the Subcommittee on Courses are my vice chair, Linda Worley and committee members Arnold Moreno, M.D.; Charles Price, M.D.; and Michael Myers, M.D. Along with Lisa Walker, course services coordinator, we have worked hard to evaluate course submissions critically to provide an exceptional, in-depth educational experience for all. The Subcommittee on Courses limits course enrollment size to maximize opportunities for participant-faculty interaction. To secure your place in a course, register early! The courses sell out quickly. Registration and enrollment information and forms can be accessed at APA’s Web site at http://annualmeeting.psychiatry.org. Links for online meeting and housing registration can also be accessed from this site.All mailed and faxed registration and pre-enrollment forms must be received at APA on or before April 23. After this date, on-site fees are in effect for meeting and course registration. The course enrollment area is located in the Javits Convention Center and the New York Hilton Midtown. Only those who have registered for the annual meeting may purchase course tickets.See you there! ■To see the registration information and the list of courses, go to http://www.psychnews.org/pdfs/2014_am_courses.pdf. ISSUES NewArchived

25: Chorioamnionitis and antenatal steroid therapy: single vs repeat course?

To date, the literature examining the risk of maternal infectious morbidity in the setting of ruptured membranes after administration of antenatal corticosteroids has been limited to single versus weekly repeat courses. We sought to evaluate whether one course versus a single repeat course of antenatal corticosteroids given in the setting of premature rupture of the membranes (PROM) increases the risk of maternal chorioamnionitis.

Treatment Strategies for Recurrent Clostridium difficile Infection

Recurrent Clostridium difficile infection represents a major clinical challenge. Treatment is often based on empiric selection from relatively few options supported by limited clinical evidence. To review and evaluate the literature on therapeutic alternatives for recurrent C. difficile infection. The MEDLINE, PubMed, Embase, and Cochrane databases were searched from inception to 2013 for published evidence in English on the treatment of recurrent C. difficile infection. The search terms were "Clostridium difficile", "recurrent" or "relapse", and "treatment". Studies of any design were eligible for inclusion. Two reviewers assessed abstracts, full articles, and reference lists from retrieved articles and clinical practice guidelines to identify relevant literature. The evidence to guide treatment of recurrent C. difficile infection is limited, with 24 studies meeting the inclusion criteria for this review. A repeat course of oral metronidazole or vancomycin is recommended for treatment of mild to moderate first recurrences and has not been found to influence the likelihood of subsequent recurrence. Oral vancomycin may be preferred for more severe infections; however, the severity score warrants further study and validation. For the treatment of second and subsequent recurrences, tapered or pulsed vancomycin regimens have been recommended in practice guidelines, despite very limited clinical evidence. Similarly, the potential benefits of longer treatment courses of oral vancomycin for second and subsequent recurrences warrant investigation. The potential role, including costs and benefits, of new agents such as fidaxomicin in the treatment of recurrent C. difficile infection remains to be determined. Although there is insufficient evidence to recommend probiotics as an adjunct to conventional treatment for recurrent infection, there may be benefit in terms of prevention. This literature review identified significant limitations in currently recommended interventions for the treatment of recurrent C. difficile infection. It has also provided insight into the available evidence for determining the appropriateness of therapy for patients with recurrent infection.

Immune Cell Phenotype and Function After Treatment With Blinatumomab For Childhood Relapsed B-Cell Precursor Acute Lymphoblastic Leukemia (BCP-ALL)

BackgroundBlinatumomab is a bi-specific monoclonal antibody designed to engage and tether cytotoxic T-cells (CTL) to CD19-expressing target B cells. An ongoing phase I multicenter study in pediatric patients with relapsed/refractory B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has shown that blinatumomab induces morphological and molecular remissions, defined as minimal residual disease (MRD) levels <10-4, in 47% of patients [Gore L, et al. J Clin Oncol 31, 2013 (suppl; abstr 10007)]. It is presently unknown whether and to what extent blinatumomab affects T-cell phenotype and function in pediatric patients with BCP-ALL. Patients and MethodsEight children diagnosed with relapsed/refractory BCP-ALL at the Bambino Gesù Children's Hospital in Rome (median age at diagnosis 5.8 years, range 0.5-14.6) received blinatumomab as continuous intravenous infusion for 28 consecutive days, followed by a 2-week drug-free period. Four out of 8 patients were given repeated treatment courses. Peripheral blood samples were collected before treatment (day 0) and weekly thereafter, for 4 consecutive weeks. Bone marrow (BM) aspirates were available on days 0 and +29 of each drug course. Peripheral blood mononuclear cells (PBMC) were labeled with appropriate combinations of fluorochrome-conjugated monoclonal antibodies to quantitate naïve/memory T cells, αβ/γδ-expressing T cells and other immune effectors with potential anti-leukemia activity, such as CD3+CD56+ natural killer (NK) T cells and CD3-CD56+ NK cells. T-cell production of interferon (IFN)-γ, interleukin (IL)-4 and IL-17 was measured at the single-cell level, after short-term (4-hour) stimulation with phorbol myristate acetate (PMA) and ionomycin. The TCR-Vβ Repertoire Kit® (Beckman Coulter, Milan, Italy) allowed the flow cytometry analysis of 24 different Vβ specificities on T cells, thus covering approximately 70% of the normal human TCR-Vβ repertoire. ResultsPeripheral blood lymphocytes reached their nadir on day +1 (median 300/µL of blood [inter-quartile range 40-380] compared with 1,080/µL of blood at baseline [inter-quartile range 360-2,310]; p=0.0037 by Mann-Whitney U test for paired data), expanded within 7 days up to 3.5-fold above baseline, and included both CD4+ and CD8+ T cells. By contrast, the frequency of both CD3+CD56+ NK T cells and CD3-CD56+ NK cells remained unchanged compared to baseline. IFN-γ production by patient-derived CD4+ T cells exceeded that observed in CD4+ T cells from healthy controls by 2-fold, indicating robust T helper type 1 (Th1) polarization. The frequency of Th2/Th17 cells, defined as CD4+IL-4+ and CD4+IL-17+ cells, respectively, was not different after treatment compared to baseline. CD31 expression on recovering CD45RA+ naïve T cells, a surrogate phenotypic feature for recent thymic emigrants (RTEs), suggested that thymic output may contribute to T-cell expansion after blinatumomab administration. Non-significant changes in the relative proportion of TCR-αβ and TCR-γδ-expressing CD3+ T cells were detected after treatment (median 79.5% TCR-αβ+ T cells and 19.3% TCR-γδ+ T cells among total CD3+ cells) compared with baseline (median 87.4% TCR-αβ+ T cells and 12.2% TCR-γδ+ T cells among total CD3+ cells). Importantly, both CD3+CD8bright T cells and NK cells expressed lytic granule proteins, such as perforin and granzyme-B, at levels that increased during treatment. The analysis of Vβ TCR repertoire revealed a restricted usage of single Vβ domains by BM-resident CD8+ T cells, but not by CD4+ T cells. Specifically, the sum of Vβ within CD8+ T cells in the BM averaged 56.7±6.2% after blinatumomab, compared with 78±5.1% in healthy controls (p=0.04; Mann-Whitney U test for unpaired data). ConclusionsBlinatumomab expands both CD31+CD45RA+ thymic-naïve and memory T cells with heightened IFN-γ production and is highly effective at clearing MRD in children with BCP-ALL. Skewing of the Vβ repertoire within BM-resident CD8+ T cells may be consistent with clonal expansions. Disclosures:Zugmaier:Amgen: Employment.

Treatment of Enterococcal Peritonitis with Intraperitoneal Daptomycin in a Vancomycin-Allergic Patient and a review of the literature

Intraperitoneal (IP) administration of antibiotics is a mainstay of therapy in the treatment of peritoneal dialysis-related peritonitis. The therapeutic options against gram-positive organisms in patients intolerant to vancomycin are limited. This case report and review of the literature used a search of PubMed with the terms "daptomycin," "intraperitoneal," and "peritoneal" for 2004 through 7 February 2013 to find relevant publications. In addition to our patient, we identified 6 case reports of IP daptomycin for the treatment of peritonitis. Our patient was treated with a 14-day course of IP daptomycin, with resolution of signs and symptoms of peritonitis. She presented again 7 weeks later with signs and symptoms of peritonitis and was treated with a repeat course of IP daptomycin. Among the 6 patients reported in the literature, 4 received loading doses of daptomycin. Daptomycin 20 mg per liter of dialysate was administered in 4 patients, and the other 2 patients received higher doses based on body weight (milligrams per kilogram). Treatment duration averaged 10 or 14 days. In all 6 cases, clinical cure was reported. Although limited to case reports, the available literature suggests that IP daptomycin is a viable alternative for peritoneal dialysis-related peritonitis. However, routine use of this agent must be cautioned, because further prospective studies are required.