Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of ...children; the American Academy of Pediatrics first published clinical recommendations for the diagnosis and evaluation of ADHD in children in 2000; recommendations for treatment followed in 2001.
To estimate the direct medical costs associated with type 2 diabetes, its complications, and its comorbidities among U.S. managed care patients.
Data were from patient surveys, chart reviews, and ...health insurance claims for 7109 people with type 2 diabetes from 8 health plans participating in the Translating Research Into Action for Diabetes (TRIAD) study between 1999 and 2002.
A generalized linear regression model was developed to estimate the association of patients' demographic characteristics, tobacco use status, treatments, related complications, and comorbidities with medical costs.
The mean annualized direct medical cost was $2465 for a white man with type 2 diabetes who had been diagnosed fewer than 15 years earlier, was treated with oral medication or diet alone, and had no complications or comorbidities. We found annualized medical costs to be 10% to 50% higher for women and for patients whose diabetes had been diagnosed 15 or more years earlier, who used tobacco, who were being treated with insulin, or who had several other complications. Coronary heart disease, congestive heart failure, hemiplegia, and amputation were each associated with 70% to 150% higher costs. Costs were approximately 300% higher for end-stage renal disease treated with dialysis and approximately 500% higher for end-stage renal disease with kidney transplantation.
Most medical costs incurred by patients with type 2 diabetes are related to complications and comorbidities. Our cost estimates can help when determining the most cost-effective interventions to prevent complications and comorbidities.
...in the novel area of integrated medicine, psychologists have brought honor and distinction to their home medical schools and academic health sciences centers consistent with their physician ...counterparts and clinical partners. While there have been few psychologists who have served as deans of schools of medicine, the representation as deans of schools of public health and schools of health professions is widespread. ...there are many psychologists who currently serve as associate deans, division chiefs, and institute directors at their respective institutions. ...the Journal has a prominent international presence whereby our psychology colleagues throughout the world have published important work and employ it as a means of connecting with others in the United States as well as throughout the world. ...please consider the Journal as a potential outlet for your work.
To estimate the health utility scores associated with type 2 diabetes, its treatments, complications, and comorbidities.
We analyzed health-related quality-of-life data, collected at baseline during ...Translating Research Into Action for Diabetes, a multicenter, prospective, observational study of diabetes care in managed care, for 7,327 individuals with type 2 diabetes. We measured quality-of-life using the EuroQol (EQ)-5D, a standardized instrument for which 1.00 indicates perfect health. We used multivariable regression to estimate the independent impact of demographic characteristics, diabetes treatments, complications, and comorbidities on health-related quality-of-life.
The mean EQ-5D-derived health utility score for those individuals with diabetes was 0.80. The modeled utility score for a nonobese, non-insulin-treated, non-Asian, non-Hispanic man with type 2 diabetes, with an annual household income of more than $40,000, and with no diabetes complications, risk factors for cardiovascular disease, or comorbidities, was 0.92. Being a woman, being obese, smoking, and having a lower household income were associated with lower utility scores. Arranging complications from least to most severe according to the reduction in health utility scores resulted in the following order: peripheral vascular disease, other heart diseases, transient ischemic attack, cerebral vascular accident, nonpainful diabetic neuropathy, congestive heart failure, dialysis, hemiplegia, painful neuropathy, and amputation.
Major diabetes complications and comorbidities are associated with decreased health-related quality-of-life. Utility estimates from our study can be used to assess the impact of diabetes on quality-of-life and conduct cost-utility analyses.
The American Psychological Association (APA), under the oversight of the Board of Educational Affairs, and the Board of Professional Affairs, is responsible for the education and training of ...psychologists in prescriptive authority. All APA standards and guidelines are required by Association Rule 30-8.3 to be revised at least every 10 years. The standards for training psychologists in the safe and responsible practice of prescribing psychotropic medication have been recently updated (Model Education and Training Program in Psychopharmacology for Prescriptive Authority, APA, 2019). A departure from the 1996 and 2009 versions of that document is that training may now be conducted at the doctoral level; however, a postdoctoral supervised clinical fellowship can only occur after the attainment of licensure as a practicing psychologist. Two novel features of the 2019 revision are the use of a competency-based model of learning and assessment, and increased emphasis on supervised clinical experiences in physical assessment and medication management. By the time of completion of their fellowships, practicing psychologists are expected to have clinical competence in the measurement and interpretation of vital signs; neurological examination; therapeutic drug monitoring; systems of care; pharmacology; clinical pharmacology; psychopharmacological research; and finally, professional, ethical, and legal issues. The updated standards were approved as APA policy in February 2019. This article briefly reviews the revision process and highlights the updates made in the most recent version of the standards.
Public Significance Statement
Standards for training psychologists in the safe and responsible practice of prescribing psychotropic medication have been recently updated. These revisions reflect a competency based model of learning coupled with the completion of psychopharmacology training at either the doctoral or postdoctoral training level. The updated standards as delineated in this article were approved as policy of the American Psychological Association.
Commentary: Consensus Findings and Future Directions Worrell, Frank C; Campbell, Linda F; Dailey, Andrew T ...
Professional psychology, research and practice,
10/2018, Letnik:
49, Številka:
5-6
Journal Article
Recenzirano
In this article, we comment on the articles in this special section based on the Summit on Master's Training in Psychological Practice. We begin with some general remarks highlighting the increased ...urgency on the topic of the master's degree in psychology as detailed in the opening article, and provide a few comments on the four areas discussed in the Summit and the special section papers: scope of practice, marketplace and workforce, quality assurance, and regulation and licensure. We then review the general areas of consensus that the Summit participants came to, summarize critical concerns that the issue of licensing individuals with master's degrees raise, and report on the preliminary discussion held by the Council of Representatives, which will make the final decision about if and how to proceed on this important policy decision for APA and for psychology.
Public Significance Statement
For many years, APA's policy limited practice in health service psychology to psychologists. Recent shortages in mental health practitioners coupled with data indicating greater shortages in the next decade resulted in an APA Summit on the Master's Degree. The results of the Summit were shared with the APA Council, which has voted to pursue accreditation for master's programs in health service psychology, signaling a major shift in APA policy.
AMD3100 is a CXCR4 receptor inhibitor with anti–HIV-1 activity in vitro. We tested the safety, pharmacokinetics, and antiviral effect of AMD3100 administered for 10 days by continuous intravenous ...infusion in an open-label dose escalation study from 2.5 to 160 μg/kg/h. Forty HIV-infected patients with an HIV RNA level >5000 copies/mL on stable antiretroviral (ARV) regimens or off therapy were enrolled. Syncytium-inducing (SI) phenotype in an MT-2 cell assay was required in higher dose cohorts. Most subjects were black (55%), male (98%), and off ARV therapy. HIV phenotype was SI (30%), non–SI (45%), or not tested (25%). One patient (5 μg/kg/h) had serious and possibly drug-related thrombocytopenia. Two patients (40 and 160 μg/kg/h) had unexpected, although not serious, premature ventricular contractions. Most patients in the 80- and 160-μg/kg/h cohorts had paresthesias. Steady-state blood concentration and area under the concentration-time curve were dose proportional across all dose levels; the median terminal elimination half-life was 8.6 hours (range8.1–11.1 hours). Leukocytosis was observed in all patients, with an estimated maximum effect of 3.4 times baseline (95% confidence interval2.9–3.9). Only 1 patient, the patient whose virus was confirmed to use purely CXCR4 and who also received the highest dose (160 μg/kg/h), had a significant 0.9-log10 copies/mL HIV RNA drop at day 11. Overall, however, the average change in viral load across all patients was +0.03 log10 HIV RNA. Given these results, AMD3100 is not being further developed for ARV therapy, but development continues for stem cell mobilization.
The master's degree has been an elusive training and practice component of psychology as early as 1947, generating well over 45 conferences and many working groups charged with determining the ...function and role of the degree within the field. In 2016, a Master's Summit was held for the same purpose and to ask the same questions including, "Should APA embrace the training of psychological practitioners at the master's level?" This article introduces the Special Section on Master's Training in Psychological Practice and reviews the early major conferences, taskforces, and reports which, over the last 70 years, have investigated the master's issue and identified the recurring topics, findings, and recommendations. Periodic, internal APA work groups on the issue have conferred in recent years but few publications have been issued since the early attention to the topic. This article first provides a brief overview of the history and context of each of four master's topics that were themes of the 2016 Master's Summit and were recurring topics of master's discussions over the years (American Psychological Association Minority Fellowship Program, 2017). These topics are (a) quality assurance and accreditation, (b) scope of practice, (c) regulation and licensure, and (d) marketplace and workforce and each of these is presented in an article in this special section. Past barriers to resolution of the master's issue are reviewed, why questions could not be answered earlier, and reasons why they may be answered now are proposed. The final article of the series identifies consensus findings and suggests future directions.
Public Significance Statement
This article highlights history of the debate regarding master's practice in psychology and describes the context that fueled the pro and con stances. Descriptions of elements of the debate-quality assurance/accreditation, scope of practice, regulation/licensure, marketplace/workforce, current barriers, and potential resolutions for the future of master's level practice-provide the context for review of the subsequent articles in this special section.
We report the 10-year effectiveness and within-trial cost-effectiveness of the Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) interventions among participants who were adherent to ...the interventions.
DPP was a 3-year randomized clinical trial followed by 7 years of open-label modified intervention follow-up.
Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. Lifestyle adherence was defined as achieving and maintaining a 5% reduction in initial body weight, and metformin adherence as taking metformin at 80% of study visits.
The relative risk reduction was 49.4% among adherent lifestyle participants and 20.8% among adherent metformin participants compared with placebo. Over 10 years, the cumulative, undiscounted, per capita direct medical costs of the interventions, as implemented during the DPP, were greater for adherent lifestyle participants ($4810) than adherent metformin participants ($2934) or placebo ($768). Over 10 years, the cumulative, per capita non-interventionrelated direct medical costs were $4250 greater for placebo participants compared with adherent lifestyle participants and $3251 greater compared with adherent metformin participants. The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.80) than metformin (6.74) or placebo (6.67). Without discounting, from a modified societal perspective (excluding participant time) and a full societal perspective (including participant time), lifestyle cost < $5000 per QALY-gained and metformin was cost saving compared with placebo.
Over 10 years, lifestyle intervention and metformin were cost-effective or cost saving compared with placebo. These analyses confirm that lifestyle and metformin represent a good value for money.
Research literature relating to the prevalence of attention-deficit/hyperactivity disorder (ADHD) and co-occurring conditions in children from primary care settings and the general population is ...reviewed as the basis of the American Academy of Pediatrics clinical practice guideline for the assessment and diagnosis of ADHD. Epidemiologic studies revealed prevalence rates generally ranging from 4% to 12% in the general population of 6 to 12 year olds. Similar or slightly lower rates of ADHD were revealed in pediatric primary care settings. Other behavioral, emotional, and learning problems significantly co-occurred with ADHD. Also reviewed were rating scales and medical tests that could be employed in evaluating ADHD. The utility of using both parent- and teacher-completed rating scales that specifically assess symptoms of ADHD in the diagnostic process was supported. Recommendations were made regarding the assessment of children with suspected ADHD in the pediatric primary care setting.
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