Biomedical subjects

Louis T van Zyl

Publications and source records attributed to Louis T van Zyl.

9 recordsLinked to original sources

PubMed2006

Canadian psychiatry residency training programs: A glance at the management structure.

OBJECTIVES: To describe the administrative functioning of all current Canadian psychiatry residency training programs (RTPs) and to suggest available improvements to existing systems. METHOD: We obtained data about the 2004 RTPs by distributing 2 questionnaires to all Canadian psychiatry RTPs. RESULTS: Residency program committees (RPCs) are mainly consultative and carry only a small amount of the workload of managing a residency program. Program directors (PDs) manage more than 80% of the work and report that the time allowance to perform their duties is suboptimal. PDs remain in office for about 5 years, departing during or at the end of a predetermined second term. CONCLUSION: RPCs bear only a small amount of the workload generated by the RTP. We piloted administrative changes that led to more equitable work distribution.

Canada↗

PubMed2006

Delirium concisely: condition is associated with increased morbidity, mortality, and length of hospitalization.

Delirium is a common neuropsychiatric condition that affects 15% to 70% of elderly medical and surgical patients. It tends to be a transient disorder, although long-term complications are not uncommon. Medical comorbidity is the rule, and predisposing, as well as precipitating, factors are important to consider in its management. Major risk factors for delirium include advanced age, cognitive impairment, and chronic medical illness. Delirium is associated with several adverse outcomes including mortality, increased length of hospital stay, increased risk of dementia, and high rates of institutional placement. Delirium is distressing for patients, families, and staff. Nonpharmacologic-integrated intervention programs may improve outcome and may be incorporated into the overall medical management.

Aged↗

PubMed2005

Relationship between release of platelet/endothelial biomarkers and plasma levels of sertraline and N-desmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression.

OBJECTIVE: In a platelet/endothelial biomarker substudy of the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART), the authors sought to determine whether plasma levels of sertraline and its primary metabolite N-desmethylsertraline affect the release of platelet/endothelial biomarkers. METHOD: Fifty-five acute coronary syndrome patients with depression were randomly assigned to receive sertraline (N=23) or placebo (N=32). Twenty-six serial plasma samples collected at week 6 (N=12) and week 16 (N=14) were analyzed. Platelet factor 4 (PF4), beta-thromboglobulin (beta-TG), platelet/endothelial cell adhesion molecule 1 (PECAM-1), P-selectin, thromboxane B(2) (TxB(2)), prostacyclin (6-keto-PGF1alpha), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin were measured by enzyme-linked immunosorbent assay. Concentrations of sertraline and N-desmethylsertraline were determined by liquid chromatography with fluorescence detection in autologous samples. RESULTS: Strong, mostly time-dependent negative correlations were found for the plasma levels of sertraline and N-desmethylsertraline with PF4 (week 6: r=-0.69 and -0.33, respectively; week 16: r=-0.63 for both), beta-TG (week 6: r=-0.43 and -0.29; week 16: r=-0.66 and -0.57), PECAM-1 (week 6: r=-0.82 and -0.49; week 16: r=-0.60 for both), P-selectin (week 6: r=-0.82 and -0.49; week 16: r=-0.73 and -0.43), and TxB(2) (week 6: r=-0.66 and -0.59; and week 16: r=-0.64 and -0.41). Regression analysis revealed some borderline correlations for endothelial markers such as 6-keto- PGF1alpha and E-selectin and a positive correlation for VCAM-1. CONCLUSIONS: This is the first documented evidence that plasma release of platelet/endothelial biomarkers is directly related to the levels of sertraline and N-desmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression. The clinical significance of these findings should be assessed in the setting of a randomized clinical trial.

Biomarkers↗

PubMed2003

Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy.

BACKGROUND: Depression after acute coronary syndromes (ACSs) has been identified as an independent risk factor for subsequent cardiac death. Enhanced platelet activation has been hypothesized to represent 1 of the mechanisms underlying this association. Selective serotonin reuptake inhibitors (SSRIs) are known to inhibit platelet activity. Whether treatment of depressed post-ACS patients with SSRIs alters platelet function was not known. Accordingly, we serially assessed the release of established platelet/endothelial biomarkers in patients treated with sertraline vs placebo in the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART). METHODS AND RESULTS: Plasma samples (baseline, week 6, and week 16) were collected from patients randomized to sertraline (n=28) or placebo (n=36). Anticoagulants, aspirin, and ADP-receptor inhibitors were permitted in this study. Platelet factor 4, beta-thromboglobulin (betaTG), platelet/endothelial cell adhesion molecule-1, P-selectin, thromboxane B2, 6-ketoprostaglandin F1a, vascular cell adhesion molecule-1, and E-selectin were measured by ELISA. Treatment with sertraline was associated with substantially less release of platelet/endothelial biomarkers than was treatment with placebo. These differences attained statistical significance for betaTG (P=0.03) at weeks 6 and 16 and for P-selectin (P=0.04) at week 16. Repeated-measures ANOVA revealed a significant advantage for sertraline vs placebo for diminishing E-selectin and betaTG concentrations across the entire treatment period. CONCLUSIONS: Treatment with sertraline in depressed post-ACS patients is associated with reductions in platelet/endothelial activation despite coadministration of widespread antiplatelet regimens including aspirin and clopidogrel. The antiplatelet and endothelium-protective properties of SSRIs might represent an attractive additional advantage in patients with depression and comorbid coronary artery and/or cerebrovascular disease.

Biomarkers↗

PubMed2003

Delirium in hospital: an underreported event at discharge.

OBJECTIVE: Delirium, an important event in hospital, is associated with significant mortality and morbidity. Most patients with delirium recover fully; however, when left untreated, delirium may progress to stupor, coma, or death. Delirium is less likely to resolve completely in elderly patients in whom persistent cognitive deficits commonly occur. The extent to which this information is available to family doctors after discharge was investigated. METHOD: A total of 31 patients with delirium who were referred to consultation-liaison psychiatry were assessed using standardized measures. Medical services completed discharge summaries on these patients; a chart review captured the extent to which the diagnosis of delirium and the involvement of psychiatry was recorded in the discharge summaries. RESULTS: In structured discharge summaries, a reference to delirium occurrence was found in 55% of cases. In unstructured discharge summaries, the reporting was much lower (16% of cases). Delirium was more likely to be reported in women than in men, when it was more severe, or when it was the principal reason for admission, rather than when it occurred during an admission for some other reason. CONCLUSIONS: Delirium episodes that occur during a period of hospitalization for treatment of any medical disorder are underreported, even when specifically diagnosed. Structured discharge summaries tend to increase the rate of reporting.

Aged↗

PubMed2002

Sertraline treatment of major depression in patients with acute MI or unstable angina.

CONTEXT: Major depressive disorder (MDD) occurs in 15% to 23% of patients with acute coronary syndromes and constitutes an independent risk factor for morbidity and mortality. However, no published evidence exists that antidepressant drugs are safe or efficacious in patients with unstable ischemic heart disease. OBJECTIVE: To evaluate the safety and efficacy of sertraline treatment of MDD in patients hospitalized for acute myocardial infarction (MI) or unstable angina and free of other life-threatening medical conditions. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled trial conducted in 40 outpatient cardiology centers and psychiatry clinics in the United States, Europe, Canada, and Australia. Enrollment began in April 1997 and follow-up ended in April 2001. PATIENTS: A total of 369 patients with MDD (64% male; mean age, 57.1 years; mean 17-item Hamilton Depression [HAM-D] score, 19.6; MI, 74%; unstable angina, 26%). INTERVENTION: After a 2-week single-blind placebo run-in, patients were randomly assigned to receive sertraline in flexible dosages of 50 to 200 mg/d (n = 186) or placebo (n = 183) for 24 weeks. MAIN OUTCOME MEASURES: The primary (safety) outcome measure was change from baseline in left ventricular ejection fraction (LVEF); secondary measures included surrogate cardiac measures and cardiovascular adverse events, as well as scores on the HAM-D scale and Clinical Global Impression Improvement scale (CGI-I) in the total randomized sample, in a group with any prior history of MDD, and in a more severe MDD subgroup defined a priori by a HAM-D score of at least 18 and history of 2 or more prior episodes of MDD. RESULTS: Sertraline had no significant effect on mean (SD) LVEF (sertraline: baseline, 54% [10%]; week 16, 54% [11%]; placebo: baseline, 52% [13%]; week 16, 53% [13%]), treatment-emergent increase in ventricular premature complex (VPC) runs (sertraline: 13.1%; placebo: 12.9%), QTc interval greater than 450 milliseconds at end point (sertraline: 12%; placebo: 13%), or other cardiac measures. All comparisons were statistically nonsignificant (P> or = .05). The incidence of severe cardiovascular adverse events was 14.5% with sertraline and 22.4% with placebo. In the total randomized sample, the CGI-I (P =.049), but not the HAM-D (P =.14), favored sertraline. The CGI-I responder rates for sertraline were significantly higher than for placebo in the total sample (67% vs 53%; P =.01), in the group with at least 1 prior episode of depression (72% vs 51%; P =.003), and in the more severe MDD group (78% vs 45%; P =.001). In the latter 2 groups, both CGI-I and HAM-D measures were significantly better in those assigned to sertraline. CONCLUSION: Our results suggest that sertraline is a safe and effective treatment for recurrent depression in patients with recent MI or unstable angina and without other life-threatening medical conditions.

Angina, Unstable↗

PubMedDate not supplied

Design and rationale for a randomized, controlled trial of interpersonal psychotherapy and citalopram for depression in coronary artery disease (CREATE).

OBJECTIVE: Recognition that depression is associated with increased morbidity and mortality in coronary artery disease (CAD) patients has augmented the need for evidence-based treatment guidelines. This article presents the design of a multisite, Canadian trial of the efficacy, safety, and tolerability of interpersonal psychotherapy (IPT), an empirically supported, depression-focused therapy, and the selective serotonin reuptake inhibitor citalopram, alone or in combination, in the treatment of major depression in CAD patients. METHODS: Two hundred eighty stable CAD patients with a current major depressive episode of at least 4 weeks' duration, based on the Structured Clinical Interview for Depression (SCID), and who have a baseline score >19 on a centralized, telephone-administered, 24-item Hamilton Depression Rating Scale (HAM-D) will be randomly assigned to receive 12 weekly IPT sessions or 12 weekly sessions of standardized clinical management (CM). Patients are also randomly assigned to receive 20 to 40 mg per day of citalopram or pill-placebo. This results in a 2-by-2 factorial design with four groups: IPT plus pill-placebo, IPT plus citalopram, CM plus pill-placebo, and CM plus citalopram. This permits the evaluation of both IPT and citalopram. Blinded, centralized, 24-item, HAM-D telephone ratings constitute the primary outcome variable. The self-report Beck Depression Inventory-II is the secondary outcome. Analyses will involve the intent-to-treat principle with last observation carried forward for incomplete assessments. RESULTS: Not applicable. CONCLUSIONS: The results of this trial will contribute to the development of evidence-based clinical guidelines for managing depression in the context of CAD.

Citalopram↗

PubMedDate not supplied

Administrative restructuring of a residency training program for improved efficiency and output.

OBJECTIVES: Canadian residency training programs (RTP) have a program director (PD) and a residency program committee (RPC) overseeing program administration. Limited guidance is available about the ideal administrative structure of an RTP. This article describes administrative load in Canadian RTPs, presents a novel approach to delegating core administrative tasks within the RTP, and provides initial impressions of positive outcomes following implementation of this new system. METHOD: All PDs of Canadian psychiatry RTPs were surveyed with respect to their program administrative structure, involvement of their training committees, and the percentage of work done by the PD compared to the rest of the RPC. At Queen's University, program domains were created representing well-defined areas within the RTP, each being assigned a program domain manager. RESULTS: RPCs were mainly consultative, averaging 14 members. The average PD: RPC workload ratio was 80:20. Three programs allowed for 50% of the program director's time to be dedicated to serving that position, with an average time dedication of 37%. CONCLUSION: The position of PD in psychiatry requires an average of 37% of the program director's time, while carrying an estimated 82% of the administrative workload. The program domain manager administration system implemented at Queen's University enabled the PD to be simultaneously up to date with all major areas of the program while experiencing a substantial decrease in the administrative workload, achieved through increased work contribution of the RPC. This system encourages closer involvement of RPC members in decision making and development of their program domains, allowing the PD more time for developing, implementing and overseeing innovations across the RTP spectrum. Furthermore, it has led to a PD: RPC workload shift from a ratio of 90:10 to one of about 60:40. Essentially, this resulted in a more efficient and adaptable RPC and RTP.

Canada↗

PubMedDate not supplied

Cardioversion of persistent atrial arrhythmia after treatment with venlafaxine in successful management of major depression and posttraumatic stress disorder.

There is increasing evidence linking depression and cardiovascular disease. However, the authors could find no literature directly linking depression with atrial fibrillation or atrial flutter. The authors report the case of a patient with uncontrolled atrial arrhythmia who cardioverted to normal sinus rhythm after treatment of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) with venlafaxine. The authors discuss comorbidity of MDD and atrial fibrillation, and explore evidence of venlafaxine as an antiarrhythmic agent. Further research is needed to establish the clinical role of venlafaxine as a Class 1 antiarrhythmic agent and any association between atrial arrhythmias and MDD and PTSD.

Antidepressive Agents, Second-Generation↗