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One of the simplest things anyone can do to help their new web site get found is to label it well. The advancement of technology has made building a website infinitely easier than it was 10 years ago. Guest Author: This is a guest article by Jessica who is a writer for the German based Reputation Observer, a comprehensive reputation management platform. I'm starting a project soon where I will have to develop and compile really simple Evaluation materials for organizations that may not have a lot of expertise to do M&E. Case studies can be particularly useful for understanding how different elements fit together and how different elements (implementation, context and other factors) have produced the observed impacts.
There are different types of case studies, which can be used for different purposes in evaluation. The following guides are particularly recommended because they distinguish between the research design (case study) and the type of data (qualitative or quantitative), and provide guidance on selecting cases, addressing causal inference, and generalizing from cases.
Note that the marketing systems and tools below have been designed to work in conjunction with the FSS System.
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The pleural effusion evaluation MedicalTemplate is suitable for any health care provider that evaluates patients with pleural effusions.A pleural effusion is a collection of excess fluid in the pleural space which is between the lungs and the chest wall. You are about to download this program (Pleural Effusion Evaluation 2), and we would like to ask you to send us your feedback after you install and try it on your computer. It won't take more than a couple of minutes, but your opinion is very important to future users of the program and to the author of the program. Needs Assessment: There has been an exponential rise in direct-to-consumer (DTC) advertising of pharmaceuticals in recent years.
CME Accreditation Statement: This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Mount Sinai School of Medicine and MBL Communications, Inc. Credit Designation: The Mount Sinai School of Medicine designates this educational activity for a maximum of 3 AMA PRA Category 1 Credit(s)TM. Faculty Disclosure Policy Statement: It is the policy of the Mount Sinai School of Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities.
To receive credit for this activity: Read this article and the two CME-designated accompanying articles, reflect on the information presented, and then complete the CME posttest and evaluation. Disclosures: The authors report no affiliation with or financial interest in any organization that may pose a conflict of interest. Please direct all correspondence to: Benjamin Lacy, MD, Chief, Behavioral Health Clinic, 1061 Harmon Ave Ste 1d03, Ft.
Direct-to-consumer (DTC) advertising of pharmaceuticals has historically been a controversial subject.
Although currently a hot topic, DTC advertising in the US has been around for nearly 300 years.2,4 In 1708, Nicholas Boone placed the first advertisement for a patent medication in a Boston newspaper. In 1981, the pharmaceutical industry proposed shifting marketing to include the consumer.1 At issue was the requirement to include extensive clinical information on the product, making it problematic to use television media to reach potential customers.
Research clearly indicates that DTC advertising alters prescribing behaviors and volume leading to greater drug expenditures.
The topic of DTC advertising is especially pertinent to the field of psychiatry where there is a desire to decrease stigma and properly educate the public on mental illness. In keeping with its mandate of examining contemporary issues in mental health, the Group for Advancement of Psychiatry (GAP) Committee on Psychopharmacology (Table 1) conducted a pilot survey study of the attitudes of psychiatric residents and psychiatric physicians on DTC marketing of medications. The questionnaire was reviewed and approved by the GAP Executive Committee and distributed to members attending one of the organization’s semi-annual meetings. During the month preceding survey completion, respondents were asked how often they had seen a DTC advertisement. Physician attitudes when dealing with DTC advertising in their clinical practice was surveyed. The authors of this article asked how respondents perceived the impact of DTC advertising on the physician-patient relationship.
Respondents were surveyed whether DTC advertising has opened an opportunity for dialogue with patients.
With respect to whether DTC advertising had improved patient compliance, most respondents (67%) did not feel that it had any effect on compliance.
Similar opinions were expressed about DTC advertising’s impact on patient awareness of treatment options. Participants were asked for opinions regarding the present regulations covering DTC advertisement. When asked who should regulate DTC advertising, respondents were invited to choose multiple responses. Regarding additional information to be included in DTC advertising, improved side-effect information was the most frequent selection (61%). From the survey responses, DTC advertising appears to be changing the nature of the physician-patient relationship. The role of the pharmaceutical industry in educating consumers about specific diseases (eg, major depression or osteoporosis), may be arguably viewed as beneficial in reducing stigma and in enhancing patient compliance with treatment.4,11,12 However, our respondents did not feel that this objective was consistently met. A significant majority of psychiatrists surveyed (78%) felt there should be changes to regulations regarding DTC advertising. The authors of this article would caution generalizing from our survey because it is a small sample. DTC marketing is an industry-sponsored initiative that has revolutionized how medical information and treatment options are disseminated to the public.
Despite the finding of an ambivalent relationship of physicians with DTC advertising, certain matters are clear. ADHD exerts a substantial toll on the lives of its sufferers and their families.1,19 This article explores the social and personal impact of ADHD on the lives of adults with this disorder, and the clinical challenges and opportunities for improving patient care through appropriate diagnosis and treatment.
ADHD has a wide-ranging impact on adult lives, manifesting as educational, interpersonal, physical, emotional, and work-related difficulties. Adults with ADHD, especially those with comorbid conduct or oppositional defiant disorder histories, are more likely to engage in behaviors resulting in incarceration.
Because the DSM-IV-TR indicates that impairments from ADHD must have an onset during childhood, diagnosis involves establishing the presence of symptoms during childhood as well as assessing current impairment.22 The DSM-IV-TR requirement for manifestation of symptoms before 7 years of age relies on parental, peer, or self-memories of childhood occurrences or records for verification.
Differences in ADHD presentation based on culture and gender pose another diagnostic challenge. Maintaining a high index of suspicion for the presence of ADHD in adults is a key aspect in making a correct diagnosis. After screening, accurate diagnosis of ADHD requires a multifaceted approach including assessments of history, present symptoms, and functional impairment (Table 4).15,40,51,53 An accurate diagnosis requires sufficient presenting symptoms from the patient, with a pervasive course since childhood, and confirmation of childhood symptoms by an outside informant. Complete evaluation of an adult with suspected ADHD should also include assessment of comorbid psychiatric diagnoses and underlying medical conditions.52 Some medical conditions may have symptoms overlapping those of ADHD or can themselves account for certain attentional symptoms. Once the diagnosis is made, patient involvement is a key element in the success of managing ADHD in adults.
After patient and family education, other treatment principles can help improve therapeutic outcomes. Stimulants are the first line of treatment for ADHD.3 Stimulants, including methylphenidate and amphetamines, have been widely and successfully used in children for decades. Reported adverse events with stimulants are generally mild or moderate in severity and include reduced appetite, weight loss, anxiety, dry mouth, headache, and insomnia.89,94 Small increases in blood pressure and pulse have been reported in patients receiving stimulants. Amphetamine and methylphenidate preparations are available in both immediate- and extended-release formulations. In 2005, the possibility of suicidal ideation with atomoxetine led to an FDA boxed warning similar to that for antidepressant medications for children and adolescents, but no such warning was required in adults based on analysis of the adult studies. The FDA has recently approved the use of two long-acting stimulants in adults with ADHD: a prolonged-release formulation of methylphenidate and lisdexamfetamine dimesylate, a long-acting prodrug.
In June 2008, the FDA approved the use in adults of a formulation of methylphenidate (MPH) in which the drug is released via an osmotic release oral system (OROS). In April 2008, the FDA approved the use in adults of a new once-daily stimulant, lisdexamfetamine dimesylate (LDX), the first long-acting prodrug indicated for the treatment of ADHD in children and adults. In addition to pharmacotherapy, nonpharmacologic interventions, such as helping the patient restructure their environment, develop organizational skills, and create better coping strategies, may be beneficial in adults with ADHD.16 Because ADHD affects the entire family, treatment interventions may involve the spouse and children in restructuring of task sharing, planning, and day-to-day functioning. The Algorithm presents a schematic to select a specific psychotherapy for target symptoms and impairments.87 A thoughtful conceptualization and application of psychotherapy will prevent the therapist from being distracted. Adult ADHD remains under-recognized, underdiagnosed, and undertreated by clinicians in the US. Stimulants that have been used in the pediatric ADHD population for decades are effective and well tolerated in adults.
The development of diagnostic tools and treatment guidelines, coupled with the use of effective and tolerable medications and effective management of comorbid conditions, should improve the quality of care for adult patients with ADHD. If you are contemplating the investment, make sure that you cana€™t get your information another way.
Title tags that say a€?Indexa€?, a€?Homea€? or only a business name arena€™t going to be enough. Utilizing them properly is a seemingly simple aspect of SEO, but doing it really well is an art form.
Links are one of the most influential factors in how a site will rank in search engines, so everyone should actively pursue them. She is a passionate Techno-enthusiast and Internet junkie who loves to write on Online Security, Social Networking (especially Facebook), Gadgets, Smartphones, Technology and SEO. Here is one of the really simple but striking tools that I came across at the community sustainability engagement evaluation toolbox Getting the right tools into people's hands is of course only part of the solution to making sure evaluation at grass roots improve. Illustrative: This is descriptive in character and intended to add realism and in-depth examples to other information about a program or policy.
Exploratory: This is also descriptive but is aimed at generating hypotheses for later investigation rather than simply providing illustration. Critical instance: This examines a single instance of unique interest, or serves as a critical test of an assertion about a program, problem or strategy.
These BETA systems below should only be used with your upline President's team authorization.
For distributors who do not have access to a club, such distributors will want to use Wellness Evaluation cards found in Mobile Wellness Coach section to invite people for a Wellness Evaluation (See Wellness Evaluation card above). Its a very power approach to offering wellness as well as developing a national organization. You should hold a minimum Herbalife position of Supervisor to engage in this recruiting system. Chest pain and difficulty breathing are the most common symptoms.Pleural effusions are concerning because they can indicate the presence of malignancies, such as lung cancer, lymphoma, metastatic cancer, or rarely, mesothelioma. If you leave your email right now we will send you tomorrow an invitation to evaluate the program. Studies suggest the average patient spends much more time each year viewing DTC ads than discussing medicines with their doctor.
The Mount Sinai School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Physicians should only claim credit commensurate with the extent of their participation in the activity.
All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Chou, MD, associate professor of psychiatry at the Mount Sinai School of Medicine, and Norman Sussman, MD, editor of Primary Psychiatry and professor of psychiatry at New York University School of Medicine.
Sussman reports no affiliation with or financial interest in any organization that may pose a conflict of interest.
DTC marketing involves stakeholders from the pharmaceutical industry, medical and healthcare sectors, public groups, and others.
For the next 230 years, advertisements for patented medications claiming to treat everything from dandruff to infidelity could be found in magazines, newspapers, and traveling medicine shows. That same year the Commissioner of the FDA, Arthur Hayes, requested the pharmaceutical industry put a voluntary moratorium on DTC advertising to allow the FDA to study their request to reduce the required disclaimers.
A systematic review of the literature by Gilbody and colleagues14 found that DTC advertisements increase both new diagnoses of a condition and the proportion of prescriptions specifically for the advertised drug. Approximately 20% of the 50 most advertised drugs in the US were medications used to treat psychiatric and neurologic disorders.17 Antidepressants, antipsychotics, and anticonvulsants are among the top five most heavily advertised classes of medicine. A questionnaire was developed by the committee to gather information about psychiatrists’ exposure, experience, and opinions regarding DTC marketing of medications. The sample was broadened to include residents and faculty in selected psychiatric training programs in Philadelphia (Temple University) and Southern California (University of Southern California; Cedars-Sinai Medical Center).
Of the media noted by the respondents, television was the most frequent (96% of responses).
Fifty-two out of 114 respondents (46%) felt that DTC had neither positively nor negatively impacted the doctor-patient relationship. Twenty-four percent thought it had a positive benefit, whereas 9% indicated it had a negative impact on medication compliance.
Twenty percent indicated that patient awareness of treatment options had improved at least a fair amount, whereas 80% felt it had helped somewhat or not at all.
Fifty-seven percent felt that DTC advertising had decreased stigma, with an additional 3% believing that DTC advertising had strongly decreased stigma. Seventy- eight percent of respondents were not satisfied with current regulations and felt that DTC advertising should be regulated differently.
This was followed by non-pharmacologic treatment options (50%), cost (48%), and information on differential diagnoses (47%). Almost all were either directly or indirectly (via colleagues or by their patients) exposed to DTC advertising. Historically, physicians have perceived themselves as uniquely expert in medical therapeutics.
Approximately 60% felt it was effective in decreasing stigma but only 20% thought it increased knowledge of illness and treatment options.
Nevertheless the views expressed by the respondents appear to be consistent with the extant literature addressing this topic.5,12,13,18 The survey examined self-reported attitudes and not necessarily actual behaviors.
Previously, only physicians and healthcare professionals were the target audience of pharmaceutical company advertising. The authors’ professional obligation to educate the patient remains and the need for dialogue has not decreased in the era of DTC marketing. Direct-to-consumer advertising under the radar: the need for realistic drugs policy in Australia. Relationship between direct-to-consumer advertising and physician diagnosing and prescribing.
Direct-to-consumer marketing of prescription drugs: a current perspective for neurologists and psychiatrists.
Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship.
Weisler is adjunct professor of psychiatry at the University of North Carolina Chapel Hill School of Medicine in Chapel Hill and adjunct associate professor of psychiatry and behavioral sciences at Duke University Medical Center in Durham, North Carolina. Editorial assistance was provided by Robert Gregory, Timothy Coffey, and Rosa Real, MD, at Excerpta Medica in Bridgewater, NJ.
The symptoms, deficits, and consequences associated with ADHD have a profound negative impact on the lives of patients and their families.
Controlled studies1,20 demonstrate that adults with untreated ADHD have poorer educational performance and attainment, significantly more marriages, greater likelihood of problems making friends, and a higher incidence of interpersonal problems than those without ADHD. In a study at the Utah State Prison of 102 randomized male inmates 16–64 years of age, 26 received a positive diagnosis of ADHD (having significant symptoms both as children and adults).
These tools vary with respect to whether they evaluate only current symptoms or include functional assessment and prior symptoms. Cardiovascular status, especially blood pressure, should be monitored while the patient is receiving stimulants. Nonetheless, it is prudent to be alert for suicidality in all patients with ADHD regardless of the choice of treatment and, in particular, in those patients with comorbid mood, anxiety, and substance use disorders.
LDX is a therapeutically inactive molecule, but after oral ingestion it is converted to l-lysine, a naturally occurring essential amino acid, and active d-amphetamine, responsible for the drug’s activity.
Because it is the very nature of the patient to be disorganized and distractible, organization and focus on the part of the therapist will ensure adherence to the therapeutic pursuit. Its prevalence and the absence of relevant professional clinical training indicate a need to educate physicians and other healthcare providers who encounter the challenging task of diagnosing ADHD in adults. Management of ADHD in adulthood requires the clinician to rule out fairly common medical conditions, such as hypertension, that may be exacerbated by stimulant treatment.
Improved recognition and treatment of ADHD should result in improved productivity in academic, work, and home environments, and should enhance quality of life for both patient and family. For example here are some of the best top 5 totally free website evaluation tools that can help you through every step of creating and growing a website. Yes, you do want to put a brand name in the title tag, but you also want to use targeted keywords. It also helps to run this tool occasionally throughout the life of your website as you move things around and make changes. Using a free ranking checker allows you to constantly monitor your sitea€™s rankings on a number of terms. The keywords you are targeting need to be matched up with the right pages in the right combination. If you want to see how your website is faring in terms of link acquisition a back link checker is the way to go. To create a website that succeeds and even thrives, it takes a lot more attention to detail, research and data analysis. This helps you to know if anything is wrong and the steps that you can take to improve the situation. This  investigates operations, often at several sites, and often with reference to a set of norms or standards about implementation processes. This examines the causal links between the program and observed effects (outputs, outcomes or impacts, depending on the timing of the evaluation) and usually involves multisite, multimethod evaluations. It is strongly recommended that when conducting a Wellness Evaluation outside a Nutrition Club, the distributor have a portable Tanita Scale (BC549) available to run body composition numbers.
This model is an advanced marketing technigue designed for distributors who are comfortable working with a corporate business environment. Fortunately, the most common causes of pleural effusions are a wide range of treatable medical conditions such as congestive heart failure (CHF), pneumonia, pancreatitis, lupus, kidney disease, liver disease, tuberculosis, and others. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. Early submission of this posttest is encouraged: please submit this posttest by November 1, 2010 to be eligible for credit.
Concerns regarding DTC marketing, including its influence on prescribing practices, and drug expenditures, are the subject of continuing debate. In 1938, Congress passed the Food, Drug, and Cosmetic Act, which gave the FDA authority over the labeling of pharmaceuticals and the Federal Trade Commission control over their advertising.
In 1985, the FDA concluded that the existing regulations to safeguard the public interest were adequate. This has a compounding effect on the number of overall prescriptions for a particular drug. The multiple choice survey was distributed at scheduled resident and faculty meetings, with voluntary completion of the questionnaire requested at the end of the meeting. This was followed by direct mailings to physicians (76%), newspaper advertisements (57%), radio advertisements (50%), direct mailings to consumers (42%), Internet or E-mail (37%), and newspaper articles (28%). Seventy-three respondents (64%) agreed that DTC had opened up an avenue for more dialogue, whereas twenty-five (22%) disagreed. The opinions on patient awareness of treatment options did not differ between male and female respondents.
In comparison, 36% thought DTC advertising had no impact, and 4% reported that DTC advertising had increased stigma on mental illness.
In descending order, they chose regulation by government associations (49%), medical associations (37%), pharmaceutical industry (9%), third-party payers (1%), and others (4%).
Most clinicians (85%) felt that DTC advertising had a minimal or negative influence on the physician-patient relationship.
DTC advertising appears to be shifting the balance with patients receiving information about medication and illness outside of the clinical encounter.
A survey by Robinson and colleagues18 querying American Medical Association members found that 73% of primary care and 65% specialty care physicians felt the need for improved regulations. For example, we did not confirm whether DTC advertising is generating changes in prescribing patterns.
In recent years, the public has increasingly become the focus of promotional marketing by the industry. Application of good medical practice principles including patient education must continue to guide clinician behavior. Barriers to diagnosing ADHD in adults include diagnostic criteria developed and field-tested in children, nonspecificity of symptoms, high incidence of comorbid disorders that could mask or distract from the ADHD diagnosis, variation in presenting symptoms by gender and ethnicity, and lack of definitive diagnostic tools. An additional 22 inmates showed varying patterns of ADHD symptoms throughout childhood and adulthood, while seven had exhibited ADHD symptoms only during childhood, and seven showed ADHD symptoms only as adults.33 Of 129 inmates of a German prison for adolescent and young adult male prisoners, ADHD (using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition34 criteria) was diagnosed in 45%. Further, symptoms may become apparent only in more challenging situations, such as at home with its demands for multitasking, and be less prominent in a work environment chosen for its suitability for ADHD.16,54 Adaptive skills, intelligence quotient, and environmental demands may make it difficult to enumerate the six of nine symptom criteria or to validate the two-domain criterion of the DSM-IV-TR. A recent study identified a group of 79 adults who fulfilled all criteria for ADHD except for onset of symptoms before 7 years of age. The clinical interview should include a medical, educational, developmental, social, family, and psychological history. Response to pharmacotherapy, psychotherapy, or both can be monitored by using the assessment scales through the course of treatment to evaluate target symptom changes.
The critical factor in distinguishing many of these conditions from ADHD is the absence of childhood cognitive or behavioral symptoms consistent with ADHD. Providing long-term support and encouragement at follow-up sessions is intrinsic to the treatment process and can also serve to significantly increase the often poor treatment adherence seen in ADHD. Patients with poorly controlled hypertension may not be eligible for stimulant treatment until their blood pressure is well controlled.91,92 Before prescribing stimulants, clinicians should ensure that the patient has no structural cardiac abnormalities or other serious cardiac problems that may place him or her at increased vulnerability to the sympathomimetic effects of stimulant drugs. The selection of short-acting or long-acting ADHD treatments varied by specialty, with long-acting agents representing 56% of primary care prescriptions, 64% of psychiatrist prescriptions, and 79% of pediatric prescriptions.
LDX was developed with the goal of providing a long duration of effect that is consistent throughout the day. Updated DSM-IV-TR diagnostic criteria that recognize adult-specific symptoms and reconsider age-threshold criteria for symptom onset are needed.

Significant cardiac disease in most cases precludes the use of stimulants in both adults and children. Future research may demonstrate whether intervention for ADHD can reduce morbidity and mortality from tragic outcomes associated with ADHD such as increased rates of motor vehicle accidents, suicide, and substance abuse and dependence. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder.
Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid?
Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community.
Driving-related risks and outcomes of attention deficit hyperactivity disorder in adolescents and young adults: a 3- to 5-year follow-up survey. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. An epidemiological study of attention-deficit hyperactivity disorder and major depression in a male prison population. ICD 10: International Statistical Classification of Diseases and Related Health Problems Volume 1. Adult outcomes of attention deficit hyperactivity disorder and conduct disorder: are the risks independent or additive?
The relationship between smoking and suicidal behavior, comorbidity, and course of illness in bipolar disorder. Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters. Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history. Screening and diagnostic utility of self-report attention deficit hyperactivity disorder scales in adults.
Use of self-ratings in the assessment of symptoms of attention deficit hyperactivity disorder in adults. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. From behavior to cognition to the brain and back: what have we learned from functional imaging studies of attention deficit hyperactivity disorder [editorial]? Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD. Executive dysfunction and cognitive impairment in a large community-based sample with multiple sclerosis from New Zealand: a descriptive study. Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop.
Cognitive performance in type 1 diabetes patients is associated with cerebral white matter volume. Normal aging increases cognitive heterogeneity: analysis of dispersion in WAIS-III scores across age. Homocysteine, folate, and vitamins B6 and B12 blood levels in relation to cognitive performance: the Maine-Syracuse study.
A psychoeducational program for children with ADHD or depression and their families: results from the CMAP Feasibility Study. A website with dead ends is unfriendly to both users and search engines, so make sure you stay on top of broken links, and use 301 re-directs on old pages that you dona€™t want anymore.
However, one of the perks of the ever expanding web is all of numerous free tools to help you strategize and collect information. Because so many medical conditions can be associated with pleural effusions, it can be difficult to positively determine the etiology. Chou receives honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Pfizer. Baron is professor and chair in the Department of Psychiatry at Temple University School of Medicine in Philadelphia, Pennsylvania.
Little is known about how mental health providers perceive the role of DTC marketing in their practices. No new legislation was introduced until 1962 when the Kefauver-Harris amendments proposed the concept of consumer protectionism when dealing with pharmaceuticals. For example, Zachry and colleagues15 found that for every $1,000 spent on advertising a cholesterol-lowering drug, there were approximately 32 new diagnoses of hyperlipidemia and 41 additional prescriptions of the advertised cholesterol lowering drug. Since the pilot information was obtained from small selected groups, survey return rates were not calculated. Since multiple responses were allowed, respondents checked off at least four types of DTC advertising on average. Information is power and the shifting balance brings up tension and ethical dilemmas when patients request specific treatments. The sample size was too small to detect statistical significance, and therefore, the authors were also unable to discern clear patterns among genders or practitioners with different levels of experience.
The authors’ pilot survey of psychiatrists revealed that DTC advertising has the potential to improve awareness of medical conditions and decrease the stigma of mental illness. Goodman is director of the Adult Attention Deficit Disorder Center of Maryland at Johns Hopkins at Green Spring Station, assistant professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, and director of Suburban Psychiatric Associates, LLC.
Given the relatively high prevalence of ADHD compared with other psychiatric disorders, clinicians should maintain a high index of suspicion and integrate screening for ADHD into all routine psychiatric evaluations. Recent data from Verispan13 indicates that prescriptions for ADHD medications for adults ≥18 years of age grew steadily from January 2003 through October 2007. Interviewing family members greatly improves the clinician’s ability to correctly identify ADHD, as others often remember impairments that the patient has forgotten or failed to recognize.
When examined by patient age, long-acting agents accounted for 78% of ADHD prescriptions in pediatric patients (0–17 years of age), but only 49% of adult ADHD prescriptions. Clinical trials of LDX in children have demonstrated significant improvements in ADHD rating scale scores compared with placebo and consistent times to maximum plasma LDX levels among the subjects.111,112 Similar results have been seen in adults. Meanwhile, clinicians can improve patient care and provide a better quality of life for these patients and their families by maintaining a high index of suspicion for ADHD, making screening for the disorder an intrinsic part of the standard psychiatric evaluation, and implementing a multifaceted approach to the diagnosis and treatment of adult ADHD. There are more than a few keyword tools out there so use more than one to fill out your keyword list. So watching and actively trying to improve your rankings can make you look bigger, and more credible. Using these tools and others like them can help you stay constantly aware of where you stand among other sites like yours. The authors surveyed 114 psychiatric physicians to assess their perspectives on the merits and risks of DTC marketing. Under these amendments, authority for drug promotional advertising review was reassigned to the FDA. However, 1997 marked the beginning of rapid growth in DTC advertising.9 This change in marketing was attributed to the new FDA guidelines on broadcast DTC marketing.
Another study5,16 comparing US and Canadian prescribing practices found that DTC advertisements resulted in significantly more frequent requests for specific advertised drugs. Further longitudinal studies are required to better characterize the dynamic nature of physician-patient relationship in an era of expanding advertising. Surveyed psychiatrists believed that DTC had little significant effect on their personal prescribing practices. Accurate diagnosis requires a comprehensive clinical interview, including evaluation of past and present symptoms and longitudinal course and assessment of functional impairment. The DSM-IV-TR would classify these patients as having a diagnosis of ADHD not otherwise specified (NOS) because they do not fulfill the age-at-onset criterion for ADHD.22 Gathering additional ADHD impairment data from family, friends, and school records from before 7 years of age can be helpful in many cases.
It can also be helpful to obtain school records to identify or corroborate childhood manifestations of ADHD.40 However, valuable supplementary information from family members or school records may often be somewhat difficult to obtain for adult patients no longer residing near their parents or schools. Extended-release preparations of methylphenidate, dexmethylphenidate, mixed amphetamine salts, and lisdexamfetamine are approved by the US Food and Drug Administration for use in adults without age restrictions. Most adverse events were mild or moderate in each treatment group and few patients discontinued treatment because of an adverse event. Longer-acting forms of stimulants and nonstimulants can improve convenience and extend control of ADHD symptoms in challenging adult environments and potentially may help decrease, but by no means eliminate, the likelihood of stimulant abuse and diversion. The results of the survey provide a perspective on the views of psychiatrists concerning DTC marketing. The FDA established requirements similar to those in existence today, ie, specifications of contraindications, effectiveness, side-effect profiles, and a cost-benefit discussion.
For the first time, drug manufacturers could present the name of the product and the condition it was intended to treat, and not report all of the contraindications. Patients making these requests were 16 times more likely to be prescribed a drug than those not making specific requests. However, >80% of respondents reported they had prescribed medications specifically requested by their patients. It is often necessary to interview or obtain information from family, friends, coworkers, and old school or test records. It is important to remember that patients classified as having a diagnosis of ADHD NOS will also usually respond to approved treatments, as recently reported by Biederman and colleagues.58 In an open-label trial in 36 adults with late-onset ADHD NOS, an extended-release preparation of methylphenidate was associated with statistical and clinical improvement of ADHD symptoms.
In a recent analysis96 of US prescribing patterns, long-acting medications were still being used more commonly to treat ADHD in children and adolescents (78%) than in adults (49%), though adults may have even greater problems with treatment adherence and drug abuse and diversion than those ≤18 years of age. Most respondents failed to endorse that DTC had a positive effect on the doctor-patient relationship, or on improved patients’ medication compliance.
A self-awareness of symptoms can be difficult for people who have lived most of their lives with the illness. However, at 40 mg of d-amphetamine and 150 mg of LDX, between-group differences in changes in liking scores were not significant.
Alternative medications offer options to those patients with stimulant intolerance or special clinical circumstances such as active substance abuse. Gross and Goin are professors of clinical psychiatry at the University of Southern California Keck School of Medicine in Los Angeles. Education of patients and their families is an important facet of treatment that can improve adherence and optimize outcome. Pharmacologic therapy includes short- and long-acting stimulants as well as second-line nonstimulant medications. Sumner is senior vice president and chief medical officer at the BioBehavioral Diagnostics Company in Cambridge, Massachusetts and clinical associate professor of Behavioral Medicine and Psychiatry at West Virginia University School of Medicine in Morgantown. Short-acting stimulants may be inconvenient and have the potential for diversion and misuse. New treatments on the horizon may offer options better fitting the needs of adults with ADHD. Fischer is Schizophrenia Research Fellow at the Maryland Psychiatric Research Center at the University of Maryland School of Medicine in Baltimore.

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