This study gave a good general impression in current educational activities and the respondents' needs and wishes for future activities worldwide, which both will be used for the development of the undergraduate pharmacovigilance core curriculum.
BackgroundFumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome.MethodsDescriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases.ResultsAll 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37–46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28–111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation.ConclusionsFAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome.
Spoken testimonials on Obsessive Compulsive Disorder (OCD) constitute the data for this study, which considers contrastive construal as evoked by conditional constructions (if, unless, what if) and antonymous uses of lexical items (bad–good, guilt–innocence). Unlike conditional language use for the expression of hypothetical scenarios, doubt, and catastrophizing, antonyms have not been a focus of OCD research. In the data, antonymous lexical items establish experiential dichotomies (e.g.,good–bad,guilt–innocence,cause–prevent) that reinforce and specify the nature of evoked contrast. Meaning making in the data, it is proposed, evokes contrastive construal according to bundles of integrated quality dimensions such asmodality,morality, andemotionthat make up incompatible conceptions of reality. Tied to contrast in the data is also the notion of balance, and contrast is considered alongside force-dynamicactionsthat are experienced as effecting balance. While the overriding concerns for the study are linguistic–conceptual, the study’s findings can have implications for research on OCD and a cognitive semantic perspective can potentially complement both content- and process-oriented psychological approaches to this disorder.
Assessment of patients referred for psychotherapy has more commonly consisted of a psychodynamic assessment with less emphasis on a formal psychiatric diagnosis, whereas the reverse tends to be the case in the general psychiatric services. Within the National Health Service there are close links between the two services. A common frame of reference regarding the definition of the patient groups using the services could Improve communication, the planning and evaluation of specific treatment programmes, and outcome studies. A retrospective case-note study was carried out at a regional psychotherapy unit in order to define the population referred between 1991 and 1992 according to ICD–10 (WHO, 1992).
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