A systematic review of measurement properties of health-status instruments is a tool for evaluating the quality of instruments. Our aim was to appraise the quality of the review process, to describe how authors assess the methodological quality of primary studies of measurement properties, and to describe how authors evaluate results of the studies. Literature searches were performed in three databases. One hundred and forty-eight reviews were included. The purpose of included reviews was to identify health status instruments used in an evaluative application and to report on the measurement properties of these instruments. Two independent reviewers selected the articles and extracted the data. Reviews were often of low quality: 22% of the reviews used one database, the search strategy was often poorly described, and in many cases it was not reported whether article selection (75%) and data extraction (71%) was done by two independent reviewers. In 11 reviews the methodological quality of the primary studies was evaluated for all measurement properties, and of these 11 reviews only 7 evaluated the results. Methods to evaluate the quality of the primary studies and the results differed widely. The poor quality of reviews hampers evidence-based selection of instruments. Guidelines for conducting and reporting systematic reviews of measurement properties should be developed.

/pdf/evaluation-of-the-methodological-quality-of-systematic-1xl4ogh2ps.pdf

Evaluation of the methodological quality of systematic reviews of health status measurement instruments

To review the pharmacokinetic literature regarding valproic acid (VPA) in patients with bipolar affective disorder to evaluate the appropriateness of routine therapeutic drug monitoring (TDM) of VPA in this population. Embase, Medline, Biosis, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Systematic Reviews databases (to July 2009) were searched (terms: valproate, valproic acid, valproate semisodium, divalproex, bipolar disorder, mania, bipolar affective disorder, assay, concentration, drug level, serum level, plasma level, therapeutic drug monitoring, drug monitoring, pharmacokinetics). A 9-step decision-making algorithm was applied to the available VPA literature in the bipolar population. VPA has been established as effective first-line therapy in the treatment of bipolar mania. Commercial assays are available to accurately measure VPA levels with good sensitivity and precision. Wide interpatient variability in VPA pharmacokinetic parameters and long anticipated treatment durations favor the use of TDM in the bipolar patient. Conversely, correlations between VPA levels and pharmacologic response in humans, and specifically patients with bipolar affective disorder are unclear. Compared with other agents known to have narrow therapeutic ranges, VPA does not seem to share this characteristic. Furthermore, the clinical efficacy and toxicity of VPA may be assessed in ways other than TDM, allowing for contributions by health care professionals, patients, and family members. Despite the development of effective and widely available VPA assays, routine monitoring of VPA concentrations in the general bipolar affective population does not seem warranted. However, TDM may enhance usual clinical monitoring in situations involving unusual VPA metabolism, polytherapy with clinically relevant drug interactions, or as part of a comprehensive assessment of treatment compliance.

Does valproic acid warrant therapeutic drug monitoring in bipolar affective disorder

Objectives Due to limited research on the association between recurrence of mood episodes and the longitudinal course of neurocognitive functioning in early phase bipolar I disorder (BD I), the impact of recurrence on neurocognition remains unclear. Further, a strong correlation between neurocognitive impairment and functional impairment has been demonstrated. The longitudinal relationship between neurocognitive impairment and functional outcome in relation to recurrence is, however, not established. Methods The current study investigated the longitudinal relationship between neurocognition, recurrence of mood episodes and functional outcome in a sample of first-treatment (FT) BD I patients (N = 42), with and without relapse, during a 1-year follow-up period. The longitudinal course of neurocognitive functioning in the patients was also compared to that of a group of healthy controls (N = 143). Results Compared to both patients with relapse and healthy controls, no-relapse patients showed neurocognitive improvements. The polarity of the relapse episodes was mostly depressive, and for the no-relapse patients, reduction of symptoms was associated with neurocognitive improvement. No-relapse patients showed better global and occupational functioning. Conclusions The current study found different neurocognitive and functional trajectories in FT BD I patients with and without relapse, with differences at follow-up to some degree being mediated by current symptoms. The current findings highlight the importance of treatment focusing on neurocognition and symptom states with the aim of improving functional recovery.

Neurocognitive functioning, clinical course and functional outcome in first-treatment bipolar I disorder patients with and without clinical relapse: A 1-year follow-up study

http://www.proseggisi.gr/wp-content/uploads/2011/06/YEJPN1397.pdf

The effect of a psycho-educational program on CARS scores and short sensory profile in autistic children

Objective: To present a tool that allows estimation of the budget impact of treatments for acute mania in bipolar I disorder from a US healthcare payer perspective.Methods: Using discrete event simulation, the course of individuals is simulated beginning with hospitalization. Discharge depends on symptom level measured by the Young Mania Rating Scale (YMRS). The treatment effect is determined using time-dependent regression equations derived from trial data, and decision rules obtained from clinical experts. Outcomes include: time to response and symptom resolution; proportion of subjects reaching each outcome; number of adverse events. Costs were obtained from hospital discharge databases, the National Medicare Physician Fee Schedule and RedBook. Different scenarios are examined, each describing the proportion of subjects on the various treatments (lithium, divalproex sodium, olanzapine, risperidone, and quetiapine – monotherapy and in combination with lithium). Analyses are intention-to-treat ov...

Budgetary impact of treating acute bipolar mania in hospitalized patients with quetiapine: an economic analysis of clinical trials.

SUMMARY

Background: In clinical trials of acute mania, a number of measures have been used to assess the severity of illness and its response to treatment. Rating instruments need to be validated in order for a clinical study to provide reliable and meaningful estimates of treatment effects.



Objective: To critically assess rating scales used in measuring mania.



Method: A systematic search of the literature, retrieval of reports of clinical trials of drugs used in mania and the rating scales and a critical and systematic appraisal of their quality.



Results: Eight symptom-rating scales were identified. The Mania Rating Scale (MRS) was the most commonly used for assessing treatment response. Two more recently developed scales are the Manchester Nurse Rating Scale for Mania (MNRS-M) and the Clinician-Administered Rating Scale for Mania (CARS-M). The latter appears well validated but its in-use reliability needs to be explored further. The translation of observed changes in instrumental ratings into clinically meaningful change has to be established further. In particular, the relative weighting to be attached to the individual items needs further study. The advantage of the MRS is that there is a relatively extensive database of studies based on it and this will no doubt ensure that it remains a gold standard for the foreseeable future.



Conclusion: Useful rating scales are available for measuring mania but further cross-validation and validation against clinically meaningful global changes are required.

Measuring mania and critical appraisal of rating scales.

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Measuring mania and critical appraisal of rating scales.