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"W. Goodman"
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Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern?
Recent guidelines from the CDC recommend gabapentinoids as first-line agents for neuropathic pain. But some clinicians may be prescribing these medications excessively for various types of acute, subacute, and chronic noncancer pain in an attempt to avoid opioids.
Journal Article
The Structure of Catalytically Active Gold on Titania
The high catalytic activity of gold clusters on oxides has been attributed to structural effects (including particle thickness and shape and metal oxidation state), as well as to support effects. We have created well-ordered gold monolayers and bilayers that completely wet (cover) the oxide support, thus eliminating particle shape and direct support effects. High-resolution electron energy loss spectroscopy and carbon monoxide adsorption confirm that the gold atoms are bonded to titanium atoms. Kinetic measurements for the catalytic oxidation of carbon monoxide show that the gold bilayer structure is significantly more active (by more than an order of magnitude) than the monolayer.
Journal Article
Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial
Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression.
We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery-Asberg Depression Rating Scale--Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point.
The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period.
The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.
Journal Article
Calcimimetic and Calcilytic Drugs: Feats, Flops, and Futures
The actions of extracellular Ca
2+
in regulating parathyroid gland and kidney functions are mediated by the extracellular calcium receptor (CaR), a G protein-coupled receptor. The CaR is one of the essential molecules maintaining systemic Ca
2+
homeostasis and is a molecular target for drugs useful in treating bone and mineral disorders. Ligands that activate the CaR are termed calcimimetics and are classified as either agonists (type I) or positive allosteric modulators (type II); calcimimetics inhibit the secretion of parathyroid hormone (PTH). Cinacalcet is a type II calcimimetic that is used to treat secondary hyperparathyroidism in patients receiving dialysis and to treat hypercalcemia in some forms of primary hyperparathyroidism. The use of cinacalcet among patients with secondary hyperparathyroidism who are managed with dialysis effectively lowers circulating PTH levels, reduces serum phosphorus and FGF23 concentrations, improves bone histopathology, and may diminish skeletal fracture rates and the need for parathyroidectomy. A second generation type II calcimimetic (AMG 416) is currently under regulatory review. Calcilytics are CaR antagonists that stimulate the secretion of PTH. Several calcilytic compounds have been evaluated as orally active anabolic therapies for postmenopausal osteoporosis but clinical development of all of them has been abandoned because they lacked clinical efficacy. Calcilytics might be repurposed for new indications like autosomal dominant hypocalcemia or other disorders beyond those involving systemic Ca
2+
homeostasis.
Journal Article
Catalytically active Au on Titania:? yet another example of a strong metal support interaction (SMSI)?
In light of the many similarities between previous studies of the so-called strong metal support interaction (SMSI) involving Gr. VIII metals, and catalytically active Au, it is apparent that these two phenomena must be closely related. That active Au on titania spreads to form a bilayer structure, is electron-rich as determined by theory and experiment, nucleates on reduced Ti defects created by annealing to temperatures > 750 K, and is deactivated via sintering in oxygen, is convincing evidence that the same basic principles responsible for activation of Au on titania are operative for SMSI involving Gr. VIII metals.
Journal Article
Perceived clinical and ethical impact of digital transformation in healthcare and research: A survey in the MENA region
The shift toward digital medical records and communication represents a transformative change in healthcare practices and research. However, this transition is marked by challenges related to the ethics of digital health adoption in fragile and conflict-affected areas, particularly in areas where healthcare providers lack prior training and preparation.
To assess healthcare and research professionals' adoption, attitudes, perceptions, and ethical considerations toward digital transformation in healthcare and research across the Middle East and North Africa (MENA) region.
A cross-sectional survey was conducted in 20 MENA countries involving 990 health professionals and researchers. Demographic data was collected, as well as questions related to the impact, attitudes, and ethics of digital health transformation. Data were analyzed using descriptive and inferential statistical methods to identify patterns and correlations between sociodemographic factors and responses.
The results indicate that digital health transformation in the MENA region was perceived as limited to moderate across key domains, with relatively positive scores on attitudes and ethical considerations. While foundational technologies, such as electronic health records, show moderate adoption, other advanced tools remain underutilized. The study also revealed a significant lack of formal training in digital health (p < 0.001) despite high digital proficiency among participants (p < 0.001). However, ethical concerns were highlighted as key issues with strong support for enhanced bioethics literacy. These findings align with the Sustainable Development Goals (SDGs) and emphasize the need to develop inclusive policies, implement robust regulatory frameworks, create targeted educational programs, make infrastructure investments, and foster stakeholder collaboration to promote the ethical use of digital health technologies.
Digital transformation in healthcare and research is viewed positively across the MENA region, but significant gaps remain in adoption, training, and governance. Addressing these gaps will be essential to ensure safe, equitable, and sustainable digital health implementation.
Journal Article
Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)
Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity, decreased quality of life, and extraskeletal calcification that have been associated with increased cardiovascular mortality. These disturbances have traditionally been termed renal osteodystrophy and classified based on bone biopsy. Kidney Disease: Improving Global Outcomes (KDIGO) sponsored a Controversies Conference on Renal Osteodystrophy to (1) develop a clear, clinically relevant, and internationally acceptable definition and classification system, (2) develop a consensus for bone biopsy evaluation and classification, and (3) evaluate laboratory and imaging markers for the clinical assessment of patients with CKD. It is recommended that (1) the term renal osteodystrophy be used exclusively to define alterations in bone morphology associated with CKD, which can be further assessed by histomorphometry, and the results reported based on a unified classification system that includes parameters of turnover, mineralization, and volume, and (2) the term CKD-Mineral and Bone Disorder (CKD-MBD) be used to describe a broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism due to CKD, which is manifested by abnormalities in bone and mineral metabolism and/or extra-skeletal calcification. The international adoption of these recommendations will greatly enhance communication, facilitate clinical decision-making, and promote the evolution of evidence-based clinical practice guidelines worldwide.
Journal Article
Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting
Objectives. We evaluated whether a brief, universal, postnatal nurse home-visiting intervention can be implemented with high penetration and fidelity, prevent emergency health care services, and promote positive parenting by infant age 6 months. Methods. Durham Connects is a manualized 4- to 7-session program to assess family needs and connect parents with community resources to improve infant health and well-being. All 4777 resident births in Durham, North Carolina, between July 1, 2009, and December 31, 2010, were randomly assigned to intervention and control conditions. A random, representative subset of 549 families received blinded interviews for impact evaluation. Results. Of all families, 80% initiated participation; adherence was 84%. Hospital records indicated that Durham Connects infants had 59% fewer infant emergency medical care episodes than did control infants. Durham Connects mothers reported fewer infant emergency care episodes and more community connections, more positive parenting behaviors, participation in higher quality out-of-home child care, and lower rates of anxiety than control mothers. Blinded observers reported higher quality home environments for Durham Connects than for control families. Conclusions. A brief universal home-visiting program implemented with high penetration and fidelity can lower costly emergency medical care and improve family outcomes.
Journal Article
Universal Reach at Birth
How do we screen all families in a population at a single time point, identify family-specific risks, and connect each family with evidence-based community resources that can help them overcome those risks—an approach known as targeted universalism? In this article, Kenneth A. Dodge and W. Benjamin Goodman describe Family Connects, a program designed to do exactly that.
Developed and tested in Durham, NC, Family Connects—now in place at 16 sites in the United States—aims to reach every family giving birth in a given community. The program rests on three pillars. The first is home visiting: trained nurses (or other program representatives) welcome new babies into the community, typically at the birthing hospital, then work with the parents to set up one or more home visits when the baby is about three weeks old so they can identify needs and connect the family with community resources. The second pillar, community alignment, is an assembly of all community resources available to families at birth, including child care agencies, mental health providers, government social services, and long-term programs for subgroups of families with identified needs, such as Healthy Families and Early Head Start. The third pillar, data and monitoring, is an electronic data system that acts as a family-specific psychosocial and educational record (much like an electronic health record) to document nurses' assessments of mother and infant, as well as connections with community agencies.
In randomized clinical trials, Family Connects has shown promising results. Compared to control group families, families randomly assigned to the program made more connections to community resources. They also reported more positive parenting behaviors and fewer serious injuries or illnesses among their infants, among other desirable outcomes. And in the first five years of life, Family Connects children were significantly less likely to be subject to Child Protective Services investigations than were children in a control group.
Journal Article