La estimulación magnética transcraneal para el tratamiento de alucinaciones auditivas refractarias en niños y adolescentes / Transcranial magnetic stimulation for treating refractory auditory hallucinations in children and adolescents

La estimulación magnética transcraneal (EMT) es una técnica novedosa, no invasiva, que utiliza la fuerza electromagnética para alterar la excitabilidad neuronal. De manera que al contrario que el TEC (terapia electroconvulsiva) no requiere anestesia y el paciente permanece despierto y monitorizado clínicamente; y al contrario que en la estimulación del nervio vago o que en la estimulación cerebral profunda los electrodos no se insertan en el cerebro. Hasta la fecha se ha utilizado en el tratamiento de distintos trastornos neuropsiquiátricos y desde el 2008 ha sido aprobada por la FDA para el tratamiento de la depresión resistente sin síntomas psicóticos. La experiencia en esquizofrenia y otras psicosis es menor y como siempre hay muchos menos estudios en la población infantil y juvenil, pero como clínicos sabemos que el inicio de la patología psiquiátrica más grave ocurre en la infancia y la adolescencia y que la mitad de todos los trastornos mentales se inician antes de la mitad de la adolescencia. En pacientes tan jóvenes es especialmente importante encontrar tratamientos más efectivos y menos dañinos. La EMT representaría una alternativa interesante, ya que puede activar algunas regiones mientras que al mismo tiempo inhibe otras; de manera que hay estudios que explican mejoría de la sintomatología negativa de la esquizofrenia mediante la estimulación del córtex frontal dorsolateral. La eficacia en el tratamiento de las alucinaciones auditivas mediante la inhibición del córtex temporal izquierdo será revisada en este artículo

Transcranial magnetic stimulation (TMS) is a novel, non-invasive neuromodulatory technique that utilices electromagnetic force to alter neuronal excitability. Hence, unlikely ECT (electroconvulsive therapy) anaesthesia is not required and the individual remains awake and clinically monitored; and in contrast with vagus nerve stimulation and deep brain stimulation, electrodes will not be placed in the brain. To date, it has been applied to a range of neuropsychiatric disorders and since 2008 it has been approved by FDA for the management of resistant depression without psychotic symptoms. Experience in schizophrenia and other psychosis is lesser and as always there are fewer studies in children and adolescentes, but as clinicians we know that the first onset of the most serious mental disorders occurs in childhood or adolescence and half of all lifetime disorders start by the mid-teens. In so young patients is specially important finding more effective treatments and less harmful. TMS would represent an interesting therapeutic alternative since it can activate some regions while at the same time it can inhibit others: for example there are studies that explain improvent in negative symptoms through dorsolateral prefrontal cortex stimulation. Efficacy on auditory hallucinations by inhibition of left temporal cortex will be reviewed below

Drug information pharmacists at health-care facilities, universities, and pharmaceutical companies.

A national survey was conducted to provide a profile of drug information pharmacists. Questionnaires were mailed to 436 drug information pharmacists whose names were obtained from directors of drug information centers (DICs) at health-care facilities, universities, and pharmaceutical companies. The net response rate was 64% (278 usable replies). Most respondents were 30 to 39 years of age and had practiced in drug information for four years or less. There were equal numbers of male and female respondents. More than half had a doctor of pharmacy (Pharm.D.) degree, and about half had completed a postgraduate residency or fellowship. Respondents with a Pharm.D. degree or postgraduate training reported a more favorable professional outcome, including position, income, and job satisfaction. Respondents reported a high level of professional involvement, including faculty appointment, publishing, and professional membership. Common reasons cited for choosing a career in drug information were an opportunity to continually learn, job satisfaction, and regular work hours. More than 70% of respondents were either very satisfied or extremely satisfied with their current job position. The most frequently reported income range was $40,000-44,999; distribution of income differed significantly among geographic regions. Drug information pharmacists report a high level of job satisfaction and involvement in professional activities; they often have completed advanced pharmacy education or postgraduate training.

A drug information service quality assurance audit.

In this quality assurance audit, 197 drug information requests received over a 10-day period were evaluated for completeness, legibility, and appropriate documentation according to standards set by the ASHP's Special Interest Group on Drug and Poison Information Practice. Deficiencies in documentation of the caller's telephone number (lacking in 21% of forms), time a response was needed (58%), background information (18%), references searched (16%), and staff review (31%) were noted. Corrective action included emphasis on quality control via improved documentation and daily review of completed consultations by senior staff. Three months later, a reaudit of 240 drug information requests found marked improvement in documentation (information regarding the above-mentioned variables was lacking in 1.7%, 2.5%, 2%, 1.3%, and 3.3%, respectively, of request forms). However, increased documentation resulted in increased response times--30% of questions were not answered the same day as asked, and 12% were not answered in the time frame requested.