Comparing Invasive and Noninvasive Blood Pressure Monitoring During General Anesthesia: Study

Recent research study aimed to compare blood pressure (BP) values recorded by invasive and noninvasive methods during normotension, hypertension, and hypotension under general anesthesia. The study also compared mean arterial pressure (MAP) values calculated by an automated technique to those obtained using a predefined formula.

The study was a prospective, observational study conducted in 250 adult patients undergoing elective surgeries under general anesthesia. Before induction, noninvasive BP (NIBP) was measured in the arm using an automated oscillometer. The radial artery in the opposite arm was then cannulated, and invasive arterial BP (ABP) was recorded simultaneously with NIBP during normotension, hypotension, and hypertension.

The key findings were:

The researchers concluded that during normotension and hypertension, DBP and MAP values were significantly higher with the NIBP technique compared to ABP, with comparable SBP. During hypotension, SBP was significantly higher with ABP, while DBP and MAP were comparable. The automated MAP values were also significantly higher than those calculated using the predefined formula.

Significance of the Study –

The study highlighted the differences in BP values obtained by invasive and noninvasive monitoring techniques under varying hemodynamic conditions, emphasizing the importance of understanding the limitations of each method to ensure accurate BP monitoring and management during surgery.

Key Points –

The 3 key points of the scientific article are:

1. The study aimed to compare blood pressure (BP) values recorded by invasive and noninvasive methods during normotension, hypertension, and hypotension under general anesthesia, as well as compare mean arterial pressure (MAP) values calculated by an automated technique to those obtained using a predefined formula.

2. The key findings were that during normotension and hypertension, diastolic blood pressure (DBP) and MAP values were significantly higher with the noninvasive BP (NIBP) technique compared to arterial BP (ABP), with comparable systolic blood pressure (SBP). During hypotension, SBP was significantly higher with ABP, while DBP and MAP were comparable. The automated MAP values were also significantly higher than those calculated using the predefined formula.

3. The study highlighted the differences in BP values obtained by invasive and noninvasive monitoring techniques under varying hemodynamic conditions, emphasizing the importance of understanding the limitations of each method to ensure accurate BP monitoring and management during surgery.

Reference –

Irimpan J, Kesavan R, Rajan S, Kumar L. Comparison of intraoperative blood pressure values measured by noninvasive versus invasive methods during normotension, hypertension, and hypotension. J Anaesthesiol Clin Pharmacol 2024;40:258‑63.

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Higher oxidative balance score tied to lower risk of kidney stones, finds study

A higher oxidative balance score is tied to a lower risk of kidney stones, according to a study published in the BMC Nephrology.

Some studies have found that the pathological formation of kidney stones is closely related to injury and inflammatory response. Behaviors such as dietary composition, physical activity, obesity and smoking can all affect the body’s oxidative stress levels. An oxidative balance score was developed to evaluate the effects of various diets and lifestyles on the body’s oxidative and antioxidant systems. To investigate whether the OBS is associated with the development of kidney stones. Data were taken from the National Health and Nutrition Examination Survey (NHANES) from 2007–2018, followed by retrospective observational studies. The association between kidney stones and OBS was analyzed using survey-weighted logistic regression by adjusting for demographics, laboratory tests, and medical comorbidity covariates. The oxidative balance score is calculated by screening 16 nutrients and 4 lifestyle factors, including 5 prooxidants and 15 antioxidants, based on prior information about the relationship between oxidation levels in the body and nutrients or lifestyle factors. Results: 26,786 adult participants were included in the study, of which 2,578, or 9.62%, had a history of nephrolithiasis. Weighted logistic regression analysis found an association between OBS and kidney stones. In the fully tuned model, i.e., model 3, the highest quartile array of OBS was associated with the lowest quartile array of OBS (OR = 0.73 (0.57, 0.92)) with the risk of kidney stone (p = 0.01), and was statistically significant and remained relatively stable in each model. At the same time, the trend test in the model is also statistically significant. With the increase of OBS, the OR value of kidney stones generally tends to decrease. There is an inverse correlation between OBS and kidney stone disease. At the same time, higher OBS suggests that antioxidant exposure is greater than pro-oxidative exposure in diet and lifestyle, and is associated with a lower risk of kidney stones

Reference:

Song, R., Wu, K., Ma, M. et al. Association between oxidative balance score and kidney stones: data from the national health and nutrition examination survey (NHANES). BMC Nephrol 25, 190 (2024). https://doi.org/10.1186/s12882-024-03607-w

Keywords:

Higher, oxidative, balance, score, lower risk, kidney stones, study, BMC Nephrology, Kidney stones, Oxidative balance score, Reactive oxygen species, National health and nutrition examination survey, Restricted cubic spline regression analysis, Song, R., Wu, K., Ma, M

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Is it time to stop recommending strict salt restriction in people with heart failure?

For decades, it’s been thought that people with heart failure should drastically reduce their dietary salt intake, but some studies have suggested that salt restriction could be harmful for these patients. A recent review in the European Journal of Clinical Investigation that assessed all relevant studies published between 2000 and 2023 has concluded that there is no proven clinical benefit to this strategy for patients with heart failure.

Most relevant randomized trials were small, and a single large, randomized clinical trial was stopped early due to futility. Although moderate to strict salt restriction was linked with better quality of life and functional status, it did not affect mortality and hospitalization rates among patients with heart failure.

“Doctors often resist making changes to age-old tenets that have no true scientific basis; however, when new good evidence surfaces, we should make an effort to embrace it,” said author Paolo Raggi MD, PhD, of the University of Alberta.

Reference:

Paolo Raggi, Salt versus no salt restriction in heart failure a review, European Journal of Clinical Investigation, https://doi.org/10.1111/eci.14265.

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Live vaccinations safe and effective among patients taking Dupilumab, reveals Study

The new advancement published in the recent issue of the Annals of Allergy, Asthma & Immunology unveiled promising insights into the safety of vaccinations for patients receiving dupilumab, a monoclonal antibody known for its efficacy in treating a variety of conditions. Dupilumab targets the interleukin (IL)-4 receptor alpha subunit to effectively block the inflammatory effects of IL-4 and IL-13, this makes it a valuable treatment for diseases such as asthma, atopic dermatitis, and eosinophilic esophagitis.

Previously, clinical trials that involved dupilumab have taken a cautious approach by excluding patients from receiving live vaccines. This precaution was reflected in the package insert that advises against administering live vaccines to individuals who undergo treatment with dupilumab. This recommendation was to prevent any potential adverse effects stemming from the immune-modulating properties of the drug. The recent approval of dupilumab use in treating atopic dermatitis in patients as young as six months has raised concerns on the pediatric patients who typically follow a vaccination schedule that includes live vaccines.

To address this, Jay Lieberman and team undertook this comprehensive systematic review of existing literature to assess the safety and efficacy of vaccinations, particularly live vaccines, in patients treated with dupilumab. The systematic review analyzed data from various studies involving patients who received vaccinations while on dupilumab. The outcomes found that overall, live vaccines were safe for patients on dupilumab and the efficacy of these vaccines was generally not compromised by the medication. This conclusion was further supported by the expert Delphi Panel, which reached a consensus that the use of vaccines in patients on dupilumab is likely both safe and effective.

Thereby, the recommendation for avoiding live vaccines in patients treated with dupilumab may need to be reconsidered. But, a shared decision-making approach is advised to ensure that patients continue to receive necessary immunizations without undue delay, to maintain their overall health and protect against preventable diseases.

Reference:

Lieberman, J. A., Chu, D. K., Ahmed, T., Dribin, T. E., Abrams, E. M., Anagnostou, A., Blumenthal, K. G., Boguniewicz, M., Chase, N. M., Golden, D. B., Hartog, N. L., Heimall, J. R., Ho, T., Lawrence, M. G., Khan, D. A., Minniear, T. D., Mustafa, S. S., Oppenheimer, J. J., Phillips, E. J., … Greenhawt, M. J. (2024). Use of Vaccines in Patients Receiving Dupilumab, A Systematic Review and Expert Delphi Consensus Recommendation: A position paper of the American College of Allergy, Asthma and Immunology. In Annals of Allergy, Asthma & Immunology. Elsevier BV. https://doi.org/10.1016/j.anai.2024.05.014

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Reteplase superior to Alteplase for Treatment of Acute Ischemic Stroke: NEJM

As a significant advancement in stroke treatment, a recent clinical trial published in the New England Journal of Medicine revealed that the thrombolytic agent reteplase may offer superior outcomes when compared to the current standard treatment, alteplase. This study involved over 1,400 patients and th outcomes suggests that reteplase could become a new standard in early reperfusion therapy for acute ischemic stroke.

This randomized trial involved patients who experienced an ischemic stroke within 4.5 hours of symptom onset. The participants were randomly assigned to receive either intravenous reteplase or intravenous alteplase. Reteplase was administered in two boluses of 18 mg each, 30 minutes apart, while alteplase was given at a dose of 0.9 mg per kilogram of body weight, with a maximum dose of 90 mg.

The primary efficacy outcome measured was the proportion of patients achieving an excellent functional outcome at 90 days post-treatment. This was defined as a score of 0 or 1 on the modified Rankin scale, where 0 indicates no neurologic deficit or symptoms, and 6 indicates death. Safety was primarily assessed by the incidence of symptomatic intracranial hemorrhage within 36 hours of treatment.

The study enrolled a total of 1,412 patients, with 707 receiving reteplase and 705 receiving alteplase. The results found that 79.5% of patients in the reteplase group achieved an excellent functional outcome when compared to 70.4% in the alteplase group. This marked a statistically significant improvement, with a risk ratio of 1.13 (95% CI, 1.05 to 1.21; P<0.001 for noninferiority and P=0.002 for superiority).

However, the safety profile of reteplase showed a slightly higher incidence of symptomatic intracranial hemorrhage within 36 hours, which was 2.4% in the reteplase group when compared to 2.0% in the alteplase group. The overall incidence of any intracranial hemorrhage at 90 days was higher in the reteplase group (7.7%) when compared to the alteplase group (4.9%), with a risk ratio of 1.59 (95% CI, 1.00 to 2.51). Also, adverse events were more common with reteplase which affected 91.6% of patients and 82.4% in the alteplase group (risk ratio, 1.11; 95% CI, 1.03 to 1.20).

Despite the higher rates of adverse events and intracranial hemorrhage, reteplase demonstrated a significantly better functional outcome than alteplase for patients treated within 4.5 hours of ischemic stroke onset. Overall, these findings suggest that reteplase could potentially replace alteplase as the standard agent for early reperfusion therapy, pending further research to optimize its safety profile.

Reference:

Li, S., Gu, H.-Q., Li, H., Wang, X., Jin, A., Guo, S., Lu, G., Che, F., Wang, W., Wei, Y., Wang, Y., Li, Z., Meng, X., Zhao, X., Liu, L., & Wang, Y. (2024). Reteplase versus Alteplase for Acute Ischemic Stroke. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2400314

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Outpatient and Inpatient Fast-Track Knee Arthroplasty Show Similar Complication Rates, unravels study

Researchers have found that outpatient and inpatient fast-track total knee arthroplasty (FT TKA) procedures result in comparable complication rates, suggesting that outpatient surgery may be a viable option for many patients without increased risk of early postoperative complications. A recent study was published in The Journal of Arthroplasty by Jean-Yves Jenny and colleagues.

Total knee arthroplasty is a common procedure aimed at relieving pain and restoring function in patients with severe knee arthritis. Traditional inpatient TKA involves several days of hospital stay, but recent advances have led to the development of fast-track protocols, which can significantly shorten recovery time. This study aimed to compare the complication rates and clinical outcomes of propensity-matched patients undergoing FT TKA in outpatient versus inpatient settings.

In this prospective study, 629 patients who underwent FT TKA were followed for 90 days post-surgery. The participants were divided into outpatient (n = 176) and inpatient (n = 462) groups based on consultations between surgeons and patients. Propensity scores based on age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were used to match outpatient to inpatient FT TKA in a 1:2 ratio. Complications were categorized into intraoperative complications, complications without readmission, complications with readmission but no reoperation, and complications with reoperation. The cumulative incidence function (CIF) was computed to analyze the time to postoperative complication diagnosis within the first 90 days.

  • After propensity score matching, 173 outpatients and 316 inpatient FT TKAs were compared.

  • The study found no significant differences in intraoperative complication rates (2% in both groups).

  • At the 90-day follow-up, total complications without readmission were 8.0% in outpatients and 7.9% in inpatients.

  • Complications with readmission but no reoperation were 1.1% for outpatients and 0.6% for inpatients.

  • Complications requiring reoperation occurred in 4.0% of outpatients and 4.4% of inpatients.

  • The CIF analysis revealed no significant differences in the timing of postoperative complication diagnosis between the outpatient and inpatient groups.

The findings indicate that outpatient FT TKA is as safe as inpatient FT TKA in terms of 90-day postoperative complication rates, intraoperative complications, readmissions, and reoperations. This supports the growing trend towards outpatient surgical pathways, which can offer benefits such as reduced healthcare costs and improved patient convenience without compromising safety.

This study demonstrates that outpatient FT TKA has similar complication rates and clinical outcomes to inpatient FT TKA, suggesting that outpatient pathways are a safe and effective option for suitable patients. These findings may encourage more surgeons to adopt outpatient FT TKA, potentially leading to broader application and benefits for patients and healthcare systems alike.

Reference:

Jenny, J.-Y., Godet, J., Muller, J. H., Kumble, A., Ramos-Pascual, S., Saffarini, M., Biette, G., Boisrenoult, P., Brochard, D., Brosset, T., Cariven, P., Chouteau, J., Hulet, C., Demey, G., Villeminot, J., & de Ladoucette, A. (2024). Complication rates are not higher after outpatient versus inpatient fast-track total knee arthroplasty: A propensity-matched prospective comparative study. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2024.06.006

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Type of weight loss surgery women undergo before pregnancy may influence children’s weight gain, reveals study

The type of weight loss surgery women undergo before becoming pregnant may affect how much weight their children gain in the first three years of life, suggests a study being presented Monday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass.

Researchers found children born to women who underwent the bariatric procedure known as sleeve gastrectomy before they became pregnant gain more weight per month on average in the first three years of life compared with children born to women who had the less common Roux-en-Y gastric bypass weight loss procedure.

“Either the extent of pre-pregnancy weight loss or the metabolic changes from Roux-en-Y gastric bypass may be favorable for the children’s early childhood weight gain,” said researcher Vidhu Thaker, M.D., of the Columbia University Irving Medical Center in New York, N.Y.

Maternal obesity is a risk factor for obesity in children. Women are more likely to conceive following weight loss procedures, but less is known about the early growth of the children born after pre-pregnancy weight loss procedures.

Sleeve gastrectomy and Roux-en-Y gastric bypass are two of the more common types of weight loss surgery, also known as bariatric and metabolic surgery. These surgeries result in sustained weight loss and improve the body’s metabolism in the majority of patients.

In vertical sleeve gastrectomy (also called gastric sleeve surgery), a surgeon removes most of the stomach, leaving only a banana-shaped section that is closed with staples. By removing a part of the stomach that makes hormones that drive hunger, this procedure also decreases appetite.

In gastric bypass, the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach directly to the lower section of the small intestine. This creates a shortcut for food, bypassing part of the stomach and the small intestine. Skipping these parts of the digestive tract means the body absorbs fewer calories and nutrients.

The researchers examined the weight and length of offspring born after pre-pregnancy weight loss procedures in the first three years of life. The study used data from 20,515 deliveries over three years, of which 450 had pre-pregnancy weight loss procedures. Among the mothers who underwent weight loss surgery, 57% had sleeve gastrectomy and 41% had Roux-en-Y gastric bypass. Long-term weight and length data were available for about half of the babies in each group.

The researchers found there was no difference in birth weight among the babies born after weight loss surgery. The pace of weight gain was higher in those born after pre-pregnancy sleeve gastrectomy compared to those born following Roux-en-Y gastric bypass, while adjusting for several other variables including pre-pregnancy body mass index.

“While we did not have data on the magnitude of weight loss following bariatric surgery, Roux-en-Y gastric bypass is known to have higher weight loss and metabolic changes compared to sleeve gastrectomy,” Thaker noted.

The authors concluded that the either the extent of pre-pregnancy weight loss or the metabolic changes from Roux-en-Y gastric bypass may be favorable for the offspring’s early childhood weight trajectory.

“A study of the mechanisms underlying the associations of the sustained pre-pregnancy weight loss and the offspring’s early life growth may also apply to other methods of weight loss, including the most recently approved anti-obesity medications,” Thaker said.  

Reference:

Type of weight loss surgery women undergo before pregnancy may influence children’s weight gain, The Endocrine Society, Meeting: ENDO 2024.

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MRI could significantly improve precision of diagnosing cleft lip and palate, reveals study

MRI could significantly improve the precision of diagnosing cleft lip and palate, reveals a study published in the Journal of Clinical Medicine.

Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish long-term treatment planning. The aim of this systematic review was to analyze the accuracy of various imaging techniques for the prenatal diagnosis of cleft lip and palate, assess the pregnancy phase for orofacial clefts diagnosis, and study the different cleft types in terms of diagnostic methods, timing, and predictability. Methods: A search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify potentially relevant studies published until January 2024. The quality of the selected articles was assessed using the Newcastle–Ottawa scale for methodological quality assessment of cohort studies and the QUADAS-2 scale for diagnostic test studies. Results: A total of 18 studies met the eligibility criteria and were included in the review. The findings of this review indicate that the majority of studies showed improved diagnostic accuracy when supplementary techniques, such as 3D ultrasound or magnetic resonance imaging, were added to 2D ultrasound. Conclusions: The implementation of magnetic resonance imaging as a standard procedure could significantly improve the precision of diagnosing cleft lip and palate. Therefore, the diagnostic technique used will play a crucial role in the accuracy of the diagnosis.

Reference:

Baeza-Pagador A, Tejero-Martínez A, Salom-Alonso L, Camañes-Gonzalvo S, García-Sanz V, Paredes-Gallardo V. Diagnostic Methods for the Prenatal Detection of Cleft Lip and Palate: A Systematic Review. Journal of Clinical Medicine. 2024; 13(7):2090. https://doi.org/10.3390/jcm13072090

Keywords:

MRI, significantly, improve, precision, diagnosing, cleft lip, palate, study, cleft lip; cleft palate; fetus; pregnancy; 2D ultrasound; 3D ultrasound; MRI; diagnosis; specificity; sensitivity, journal of clinical medicine, Baeza-Pagador A, Tejero-Martínez A, Salom-Alonso L, Camañes-Gonzalvo S, García-Sanz V, Paredes-Gallardo V

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Early Life Urinary Eicosanoid Levels Linked to Childhood Atopic Disease Risk: Study

Denmark: In a groundbreaking study, researchers have uncovered a significant association between urinary eicosanoid levels in early life and the risk of developing atopic diseases in childhood. This research sheds new light on the potential role of eicosanoids—biologically active lipid compounds derived from fatty acids—in the pathogenesis of allergic conditions and offers insights into early prevention strategies.

The study, published in The Journal of Allergy and Clinical Immunology, suggests that early life perturbations in the eicosanoid metabolism are present before the atopic disease onset in childhood, providing pathophysiological insight into the inception of atopic diseases.

Atopic diseases, including asthma, allergic rhinitis, and eczema, are common chronic conditions that affect millions of children worldwide. Despite extensive research, the precise mechanisms underlying the development of atopic diseases remain incompletely understood, highlighting the need for further exploration into novel biomarkers and risk factors.

Eicosanoids are lipid mediators, including prostaglandins (PGs), thromboxanes (TXs), and leukotrienes (LTs) with a pathophysiological role in established atopic disease. However, there is no clarity on their role in the inception of the disease. Liang Chen, University of Copenhagen, Copenhagen, Denmark, and colleagues aimed to investigate the association between urinary eicosanoids in early life and the development of atopic disease.

For this purpose, the researchers quantified the levels of 21 eicosanoids in urine from children from the COPSAC2010 (age 1 year, n=450) and VDAART (age 3 years, n=575) mother-child cohorts. They analyzed the associations with the development of atopic dermatitis, wheeze/asthma, and biomarkers of type-2 inflammation, applying FDR5% multiple testing correction.

The study led to the following findings:

· In both cohorts, analyses adjusted for environmental determinants showed that higher TXA2 eicosanoids in early life were associated with an increased risk of developing atopic dermatitis (P%)>

· In VDAART, lower PGE2 and PGI2 eicosanoids and higher isoprostanes were also associated with an increased risk of atopic dermatitis (P%).

· For asthma/wheeze, analyses in COPSAC2010 showed that lower isoprostanes and PGF2 eicosanoids and higher PGD2 eicosanoids at age 1 year were associated with an increased risk at age 1-10 years. In contrast, analyses in VDAART showed that lower PGE2 and higher TXA2 eicosanoids at age three years were associated with an increased risk at six years (P%).

“Early life perturbations in the eicosanoid pathways measured in urine samples may predict later risk of atopic disease and provide pathophysiological insight in the inception of atopic diseases,” the researchers wrote.

Reference:

Chen L, Brustad N, Kim M, Luo Y, Wang T, Ali M, Prince N, Chen Y, Chu S, Begum S, Mendez K, Kelly RS, Schoos AM, Rasmussen MA, Zurita J, Kolmert J, Stokholm J, Litonjua A, Weiss ST, Bønnelykke K, Wheelock CE, Lasky-Su J, Chawes B. Urinary eicosanoid levels in early life and risk of atopic disease in childhood. J Allergy Clin Immunol. 2024 May 31:S0091-6749(24)00565-7. doi: 10.1016/j.jaci.2024.05.022. Epub ahead of print. PMID: 38825025.

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Electroconvulsive therapy or ketamine? Clinical factors affect outcomes

Patients with moderate to severe treatment-resistant depression (TRD) might have better symptom relief from ketamine infusions than from electroconvulsive therapy (ECT), but those with severe TRD could benefit more from ECT early in treatment, an analysis led by a UT Southwestern Medical Center researcher shows. The findings, published in JAMA Network Open, are the first to identify characteristics that distinguish which treatments might benefit TRD patients more.

“Patients with TRD and their physicians can incorporate these findings in their shared decision-making process when selecting between ketamine and ECT,” said first author Manish Jha, M.D., Associate Professor of Psychiatry and an O’Donnell Clinical Neuroscience Scholar at UT Southwestern. Dr. Jha is also an Investigator in the Peter O’Donnell Jr. Brain Institute.

Previous studies have suggested that up to a third of adults with major depressive disorder have TRD, meaning they haven’t experienced adequate improvement with two or more courses of antidepressants. For decades, doctors have treated TRD patients with ECT, which delivers a jolt of electricity to the brain. More recently, ketamine – a drug historically used as an anesthetic – has also been used to treat TRD.

In a study known as the ELEKT-D clinical trial that published last year in the New England Journal of Medicine and was led by Amit Anand, M.D., Professor of Psychiatry at Harvard Medical School, Dr. Jha and his colleagues showed that ECT and ketamine produced comparable results in a group of 403 patients with TRD at five U.S. medical centers. However, it was unclear whether patients’ baseline characteristics could predict which would be more beneficial.

So Dr. Jha and research colleagues across the U.S. analyzed ELEKT-D’s results in a subgroup of 365 patients – 195 had received up to six ketamine infusions over three weeks, and 170 had received up to nine ECT treatments over three weeks. Twice weekly during the treatment phase and at one follow-up after their treatments ended, these patients filled out a questionnaire designed to assess their depression symptoms. The questionnaire was developed by former UTSW physician-researcher A. John Rush, M.D., Professor Emeritus at the Duke-NUS Medical School at the National University of Singapore, and Madhukar Trivedi, M.D., Professor of Psychiatry, Chief of the Division of Mood Disorders, and founding Director of the Center for Depression Research and Clinical Care at UT Southwestern.

The patients also were assessed with a clinician-administered diagnostic tool. In addition, they underwent evaluations assessing various demographic and clinical characteristics, such as age, sex, concurrent use of other treatments, cognitive function, and whether they were being treated for their depression as an inpatient or outpatient.

When the researchers compared the patients’ symptom assessments over three weeks with their demographic and clinical characteristics, they found that patients were most likely to benefit from ketamine if they had moderate to severe overall depression at baseline or were receiving treatments as outpatients. Patients with very severe depression or who received their treatments as inpatients had more benefit early in their treatment course from ECT. However, by their last appointment, patients with these characteristics who received ketamine had similar outcomes.

Dr. Jha noted that a variety of factors go into deciding which treatment is the best fit for patients with TRD, including whether they can conveniently access the treatment, if insurance will cover it, and possible side effects. The findings from this analysis add another factor that patients and doctors can consider when choosing the best option, he said.

Reference:

Jha MK, Wilkinson ST, Krishnan K, et al. Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2417786. doi:10.1001/jamanetworkopen.2024.17786.

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