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    <recommendedItem id="20100101_19_395"
                     title="Evidence-Based Care Cuts ADHD Symptoms, Not Impairment (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Pediatrics/ADHD-ADD/tb/18292?impressionId=1265789026575"
                     
      Adhering to guidelines when treating children with attention deficit hyperactivity disorder (ADHD) relieved symptoms but had no effect on kids&apos; performance in school or in their relationships with others, researchers found.&lt;br&gt;
&lt;br&gt;Although parents and teachers noted significant improvements in symptoms among ADHD kids (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) in a special treatment program, there weren&apos;t similar outcomes for functional impairment, Jeffery N. Epstein, PhD, of the Center for ADHD at Cincinnati Children&apos;s Hospital in Ohio, reported in the February &lt;em&gt;Archives of Pediatrics and Adolescent Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;This finding highlights the need for physicians to work with or refer patients to educational and mental healthcare specialists who can work with children to develop skills to address targeted areas of deficit,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;University-associated trials have shown stimulants are effective against ADHD, but these findings may not be translated into community practices  --  a potential public health concern, the researchers suggested.&lt;/p&gt;
&lt;p&gt;Guidelines for proper treatment exist, but they can be difficult to put into practice because of time, effort, and reimbursement concerns.&lt;/p&gt;
&lt;p&gt;So the researchers decided to test the efficacy of a quality improvement intervention called ADHD Collaborative, designed to enhance physician adherence to evidence-based, ADHD treatment guidelines.&lt;/p&gt;
&lt;p&gt;They conducted a case series involving 785 children ages 7 to 11, who were treated by 158 physicians at rural, suburban, and urban practices.&lt;/p&gt;
&lt;p&gt;The researchers found that, based on teacher and parent ratings, children showed vast improvements in ADHD symptoms (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;&quot;Improvement of ADHD symptoms occurred mainly in the first three months of treatment and remained improved and relatively stable thereafter,&quot; the researchers wrote. &quot;These results suggest that community-based physicians can achieve gains in ADHD symptom improvement comparable with carefully controlled, university-based clinical trials.&quot;&lt;/p&gt;
&lt;p&gt;However, there were no significant improvements in functional impairment as measured by parents and teachers.&lt;/p&gt;
&lt;p&gt;The proportion of functionally impaired children didn&apos;t change after treatment for any outcomes except teachers&apos; ratings of writing and assignment completion (&lt;em&gt;P&lt;/em&gt;=0.03 and &lt;em&gt;P&lt;/em&gt;=0.04, respectively).&lt;/p&gt;
&lt;p&gt;&quot;Effective treatment likely requires a multimodal strategy that includes a focus on teaching children [organizational and learning] skills,&quot; they wrote, adding that collaboration with other mental health or educational services &quot;appears to be warranted.&quot;&lt;/p&gt;
&lt;p&gt;Researchers said the study was limited because it didn&apos;t have a control group. Thus, it couldn&apos;t determine whether a similar pattern of treatment response would have been observed without physician training.&lt;/p&gt;
&lt;p&gt;The lack of a control group also made it impossible to account for any potential placebo effects.&lt;/p&gt;
&lt;p&gt;Finally, the authors didn&apos;t collect data on medication adherence.&lt;/p&gt;
&lt;p&gt;Still, they concluded that &quot;large improvements in symptoms can be achieved in primary care settings when physicians provide evidence-based ADHD care using medication.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Cincinnati Children&apos;s Hospital Medical Center Patient Innovation Fund.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_296"
                     title="FDA Okays Morphine for Tolerant Patients"
                     score="0.005"
                     href="http://www.medpagetoday.com/PainManagement/PainManagement/tb/18157?impressionId=1265789026575"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved the first high-concentration, oral morphine sulfate solution as part of its unapproved drugs initiative.&lt;/p&gt;
&lt;p&gt;The drug is indicated for opioid-tolerant patients with moderate-to-severe acute and chronic pain, as well as end-of-life care.&lt;/p&gt;
&lt;p&gt;Opioid tolerance was defined as a patient using 60 mg of an opioid per day, Sharon Hertz, MD, deputy director of the Division of Anesthesia, Analgesics, and Rheumatoid Products at the Center for Drug Evaluation and Research, said in a conference call.&lt;/p&gt;
&lt;p&gt;The new solution is available in 100 mg per 5 mL and 20 mg per 1 mL concentrations.&lt;/p&gt;
&lt;p&gt;Although morphine use in pain management has been a common practice, this form and concentration of the drug was not previously FDA approved.&lt;/p&gt;
&lt;p&gt;Approval for the new drug was based on efficacy and safety data already available, which applicants can use when seeking approval for unapproved formulations of drugs with a known safety profile, Hertz said.&lt;/p&gt;
&lt;p&gt;The FDA initiated the unapproved drugs initiative in March, 2009, when it sent warning letters to nine companies requesting they pull a number of morphine sulfate, oxycodone, and hydromorphone products from the market. (See &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/13526&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/13526&quot; target=&quot;_blank&quot;&gt;FDA Acts Against Unapproved Narcotic Drugs&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Seven of the warned companies produced unapproved concentrated morphine sulfate, but the FDA granted a reprieve from the initiative when it could not find a suitable approved replacement for the drug without disrupting patient care. (See &lt;a href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/13682&quot; mce_href=&quot;http://www.medpagetoday.com/ProductAlert/Prescriptions/13682&quot; target=&quot;_blank&quot;&gt;FDA Gives Temporary Reprieve to Unapproved Morphine Elixir&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The agency worked with manufacturer Roxane Laboratories to ensure that a sufficient supply of the drug was available and to develop a prescription and use guide for the medication.&lt;/p&gt;
&lt;p&gt;As part of the approval, the manufacturer needed to establish a safety profile prior to approval to address the risks of morphine misuse, abuse, and overdose.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_263"
                     title="Handedness Linked to ADHD (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18113?impressionId=1265789026575"
                     
      &lt;p&gt;Ambidextrous 5-year-olds are more likely to develop attention deficit-hyperactivity disorder symptoms later on as compared with right- and left-handed children, according to a study by a team of Swedish researchers.&lt;/p&gt;
&lt;p&gt;The findings are an indication that brain morphology and neural circuitry associated with handedness also affects cognitive and behavioral function, according to Alina Rodriguez, PhD, of Uppsala University in Sweden, and colleagues in an online report in &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The conclusions emerged from a longitudinal study of 7,871 children in northern Finland born in 1986, of whom 87 were mixed-handed, 632 showed a left-hand preference, and the remainder were right-handed at age 5.&lt;/p&gt;
&lt;p&gt;Rodriguez and colleagues found that when these children were tested at age 8, teachers were about twice as likely to report hyperactivity (odds ratio 2.06, 95% CI 1.09 to 3.91) or a combination of inattention and hyperactivity (OR 2.16, 95% CI 1.21 to 3.86) in the mixed-handed children compared with the right-handed ones.&lt;/p&gt;
&lt;p&gt;Similar increases in rates of teacher assessments of probable psychiatric disturbance and in overall school performance, as well as in parental reports of language problems, were seen in the ambidextrous children.&lt;/p&gt;
&lt;p&gt;Moreover, these learning and behavioral problems persisted into adolescence.&lt;/p&gt;
&lt;p&gt;Cohort members were evaluated at age 16 by parents on ADHD symptoms and provided self-reports of language and math performance in school.&lt;/p&gt;
&lt;p&gt;Those classed as mixed-handed were more than three times as likely to suffer inattention (OR 3.53, 95% CI 1.65 to 7.53) or a combination of inattention and hyperactivity-impulsivity (OR 3.16, 95% CI 1.42 to 7.08) relative to right-handed 16-year-olds, according to their parents.&lt;/p&gt;
&lt;p&gt;Self-reported problems in Finnish language and math classes were also significantly more common in the mixed-handed youths (OR 1.85, 95% CI 1.00 to 3.43 for language; OR 2.55, 95% CI 1.48 to 4.37 for math).&lt;/p&gt;
&lt;p&gt;These effects were not seen in left-handed children, Rodriguez and colleagues reported.&lt;/p&gt;
&lt;p&gt;&quot;Mixed-handedness can be used as a marker of risk for difficulties and warrants additional evaluation,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Adjusting for gender and birth weight and gestational age reduced the strength of the association between mixed-handedness and behavioral and learning problems. The point estimates of odds ratios for inattention and/or hyperactivity declined 1.4 to 1.6 and statistical significance was lost.&lt;/p&gt;
&lt;p&gt;But that actually supports the hypothesis that brain abnormalities stemming from before birth underlie what they called &quot;atypical lateralization&quot; and subsequent learning and behavior problems, Rodriguez and colleagues indicated.&lt;/p&gt;
&lt;p&gt;&quot;Recent neuropsychological work related to patterns of brain organization and function corroborates our findings,&quot; they added.&lt;/p&gt;
&lt;p&gt;They cited research indicating that ADHD is associated with left-side motor deficits, apart from hand preference, as well as reduced attention to visual stimuli on the left versus right side. These observations suggest weaker right hemisphere function, Rodriguez and colleagues argued.&lt;/p&gt;
&lt;p&gt;Other studies have suggested that neural transmission can be asymmetric between hemispheres, they said.&lt;/p&gt;
&lt;p&gt;&quot;These studies together highlight the possible interconnection among mixed-handedness, neurotransmitter dysfunction in the right hemisphere, and ADHD symptoms,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors pointed out that the &quot;impreciseness of handedness as a proxy for atypical lateralization is a limitation.&quot; Yet, the cost of direct assessment of the brain by imaging or electrical activity is &quot;prohibitive&quot; so handedness was a &quot;feasible alternative for large epidemiologic studies.&quot;&lt;/p&gt;
&lt;p&gt;And they said that even though the number of prevalence of mixed-handedness was low, &quot;it seems unlikely that those with right- or left-handedness were misclassified as mixed.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Academy of Finland, Sigrid Juselius Foundation, Thule Institute, University of Oulu, Finland, and the National Institute of Mental Health. Rodriguez also was supported by VINNMER.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_252"
                     title="MS Walking Drug Gets FDA Nod"
                     score="0.001"
                     href="http://www.medpagetoday.com/Neurology/MultipleSclerosis/tb/18112?impressionId=1265789026575"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved the first drug that improves walking in patients with multiple sclerosis, the tablet dalfampridine (Ampyra).&lt;/p&gt;
&lt;p&gt;The approval was based on clinical trial data that found patients could walk better with the drug than those treated with placebo.&lt;/p&gt;
&lt;p&gt;Patients who exceed recommended dosage, 10 mg twice a day, or who have moderate to severe kidney disease, may experience seizures the FDA said.&lt;/p&gt;
&lt;p&gt;Adverse events reported during clinical trials include urinary tract infection, insomnia, dizziness, headache, nausea, weakness, back pain, balance disorder, swelling of the nose or throat, constipation, diarrhea, indigestion, throat pain, and burning, tingling, or itching skin.&lt;/p&gt;
&lt;p&gt;The drug is manufactured by Elan of Dublin, Ireland and distributed by Acorda Therapeutics Inc. of Hawthone, NY.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_166"
                     title="APsaA: Are Physicians Too Quick to Medicate ADHD?"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/17991?impressionId=1265789026575"
                     
      &lt;p&gt;NEW YORK  --  Physicians may be too quick to medicate children suspected of having attention deficit hyperactivity disorder (ADHD), researchers said here.&lt;/p&gt;
&lt;p&gt;The etiology of the disease is not well understood, and while some cases may have neurological causes, children may respond to psychotherapy instead, Esther Fine, PhD, a psychoanalyst in private practice in Los Angeles, told attendees at the American Psychoanalytic Association meeting.&lt;/p&gt;
&lt;p&gt;&quot;Unfortunately, it is now a prevalent notion that it is no longer necessary or relevant to understand the unconscious meaning of psychological symptoms,&quot; Dr. Fine cautioned during a scientific paper presentation. &quot;It&apos;s becoming a popular idea to consider psychoanalysis, and even psychotherapy, &apos;dinosaurs&apos; in the treatment of mental disorders.&quot;&lt;/p&gt;
&lt;p&gt;Fine said that between 1990 and 1998, the number of children and adults diagnosed with ADHD rose from 900,000 to nearly 5 million.&lt;/p&gt;
&lt;p&gt;The increase coincides with a broader trend toward prescribing stimulants for its treatment. Since 1990, prescriptions have risen by 700%, Fine said.&lt;/p&gt;
&lt;p&gt;On the other hand, the proportion of children referred to psychotherapy for ADHD fell from 40% in 1989 to 25% in 1996, and Fine said that number is even lower today.&lt;/p&gt;
&lt;p&gt;One reason is that teachers may be diagnosing children as having ADHD. Concerned parents then request medications from pediatricians, Fine said, and pediatricians may be too quick to comply.&lt;/p&gt;
&lt;p&gt;&quot;Teachers and parents are looking for a quick fix,&quot; added Mark D. Smaller, PhD, a psychoanalyst in private practice in Chicago who was not involved in the paper. &quot;They&apos;re reluctant to look at what&apos;s behind that behavior, at what&apos;s going on at home.&quot;&lt;/p&gt;
&lt;p&gt;On the other hand, psychoanalytic psychotherapy may provide patients  --  even young ones  --  with an opportunity to understand how their minds work, and why it works the way it does.&lt;/p&gt;
&lt;p&gt;For example, Fine said some disorders can have roots in abusive child-rearing patterns.&lt;/p&gt;
&lt;p&gt;&quot;Certainly, parental child abuse might well set the scene for an attention deficit disorder,&quot; she said.&lt;/p&gt;
&lt;p&gt;In a case report, Fine discussed working with a school-aged patient who had a troubled childhood. After a few sessions, she discovered the underlying reasons for the young patient&apos;s anxiety and aggression, and how they affected his relationships and his ability to learn in school.&lt;/p&gt;
&lt;p&gt;&quot;Clearly it did not indicate that his problems were due to some form of brain impairment,&quot; she wrote in the case report.&lt;/p&gt;
&lt;p&gt;Smaller said that if the therapist does &quot;a full evaluation of the child and the parents, you&apos;ll get a much better sense of what&apos;s going on,&quot; and a better idea of disease etiology so it can be treated.&lt;/p&gt;
&lt;p&gt;Fine said her patient began improving in school before his parents divorced, resulting in his mother moving away and not returning him to therapy sessions.&lt;/p&gt;
&lt;p&gt;She added that there may be other reasons parents avoid psychotherapy for their children.&lt;/p&gt;
&lt;p&gt;&quot;Parents prefer to believe there is a neurological basis for their children&apos;s behavior, as it relieves the guilt that the child&apos;s difficulties may be related to their inadequate parenting skills,&quot; she said. &quot;This tends to mask the family entanglements that might contribute to an overstimulating environment.&quot;&lt;/p&gt;
&lt;p&gt;She said ADHD certainly has many different symptoms and causes, so she doesn&apos;t mean &quot;to suggest that there are no children who suffer from a neurologically-based ADHD, or that medication should never be used.&quot;&lt;/p&gt;
&lt;p&gt;She does, however, caution against &quot;a rush to judgment.&quot;&lt;/p&gt;
&lt;p&gt;Other attendees stressed that, in some cases, medication may be the way to go. &lt;div class=&quot;MsoNormal&quot;&gt;&quot;I work with children a lot and I always try to get at the underlying mechanism for their behaviors,&quot; said Mirel Goldstein, MA, MS, of St. Mary&apos;s Hospital in Passaic, N.J.  &quot;But you really need to look at it on a case-by-case basis. Sometimes medication will be the appropriate treatment.&quot;&lt;/div&gt; &lt;/p&gt;

    </recommendedItem>
</recommendedContent>