scholarly journals Risks and benefits of rapid clozapine titration

2016 ◽  
Vol 8 (1) ◽  
pp. 14-15
Author(s):  
Jeannie D. Lochhead ◽  
Michele A. Nelson ◽  
Alan L. Schneider
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Gold Standard ◽  
Therapeutic Response ◽  
Treatment Resistance ◽  
Risks And Benefits ◽  
Emotional Suffering ◽  
Life Threatening ◽  
Potential Risks ◽  
Care Costs

Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid cloza-pine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

scholarly journals Risks and benefits of rapid clozapine titration

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Jeannie D. Lochhead ◽  
Michele A. Nelson ◽  
Alan L. Schneider
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Gold Standard ◽  
Therapeutic Response ◽  
Treatment Resistance ◽  
Risks And Benefits ◽  
Emotional Suffering ◽  
Life Threatening ◽  
Potential Risks ◽  
Care Costs

Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

Rationalisation of Diagnostic and Therapeutic Choices in Prostatic Hypertrophy

1997 ◽  
Vol 64 (3) ◽  
pp. 314-319
Author(s):  
C. Monaco ◽  
G. Olivo ◽  
A. Lotto
Keyword(s):  
Health Care ◽  
Gold Standard ◽  
Cost Benefit ◽  
Benign Prostatic Hypertrophy ◽  
Alternative Therapies ◽  
Prostatic Hypertrophy ◽  
Benefit Ratio ◽  
Therapeutic Procedures ◽  
Cost Benefit Ratio ◽  
Care Costs

In order to control health care costs, urologists are being urged to review diagnostic and therapeutic procedures. A review was made of some diagnostic choices and alternative therapies for benign prostatic hypertrophy, which is the most frequently encountered pathology in clinical practice. Despite the numerous methods in being, transurethral resection of the prostate is still the gold standard in the treatment of this pathology at an acceptable cost-benefit ratio.

scholarly journals Rate of Adverse Events and Associated Health Care Costs for the Management of Inflammatory Bowel Disease in Germany

2020 ◽  
Vol 42 (1) ◽  
pp. 130-143.e3 ◽  
Author(s):  
Thomas Wilke ◽  
Antje Groth ◽  
Gráinne H. Long ◽  
Amanda R. Tatro ◽  
Diana Sun
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Adverse Events ◽  
Health Care Costs ◽  
Bowel Disease ◽  
Inflammatory Bowel ◽  
Care Costs

scholarly journals Direct access physiotherapy for patients with musculoskeletal disorders: a systematic review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Demont ◽  
A Bourmaud ◽  
A Kechichian ◽  
F Desmeules
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Adverse Events ◽  
Usual Care ◽  
Musculoskeletal Disorders ◽  
Health Care Costs ◽  
Family Physician ◽  
Direct Access ◽  
The Impact ◽  
Care Costs

Abstract Background Although the benefits of physiotherapy is well supported in the literature, the impact of having direct access to physiotherapy is not well established. Update of the current available evidence is warranted. The aim of this systematic review was to update the current evidence regarding the impact of direct access physiotherapy compared to usual care for patients with musculoskeletal disorders. Methods Systematic searches were conducted in 5 bibliographic databases up until May 2018. Two independent raters reviewed studies and used the Quality Assessment Tool for Quantitative Studies to conduct the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction and health care costs. Results Sixteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual family physician led care and direct access physiotherapy. However, three studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. Five studies did not observe any adverse events with direct access physiotherapy. Three studies showed shorter waiting time and four studies reported fewer number of physiotherapy visits with direct access. Three studies showed that patients with direct access were less likely to have medication and imaging tests prescribed compared to usual care. Five studies reported higher levels of satisfaction for direct access. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care. Conclusions Emerging evidence, although of weak to moderate quality, suggest that direct access physiotherapy provides equal or better outcomes than family physician led care models for musculoskeletal disorders patients. More methodologically strong studies are needed. Key messages This review supports the efficacy, safety and cost-effectiveness of direct access PT, while increasing access to care with a more efficient use of resources. There is a need for more methodologically strong studies to evaluate the efficiency of direct access models of care of physiotherapy for patients with MSKD.

scholarly journals Communicating Effectively About Emergency Use Authorization and Vaccines in the COVID-19 Pandemic

2020 ◽  
pp. e1-e4
Author(s):  
Sandra Crouse Quinn ◽  
Amelia M. Jamison ◽  
Vicki Freimuth
Keyword(s):  
Diagnostic Procedure ◽  
Approval Process ◽  
Off Label Use ◽  
Off Label ◽  
Risks And Benefits ◽  
The Us ◽  
Life Threatening ◽  
Potential Benefits ◽  
Accelerated Approval ◽  
Potential Risks

The Emergency Use Authorization (EUA) mechanism is central to the US response to coronavirus disease 2019 (COVID-19). It allows the US Food and Drug Administration (FDA) to respond quickly to novel threats by approving a new drug, device, or diagnostic procedure or expanding off-label use of an existing drug through an accelerated approval process.1 To obtain authorization, evidence must support that a drug or product “‘may be effective’ to prevent, diagnose, or treat serious or life-threatening diseases or conditions,” and the known or potential benefits of the product must outweigh known or potential risks.2(p7) The authorization also stipulates that when feasible, a fact sheet is provided to address risks and benefits and make clear that acceptance is voluntary.2 (Am J Public Health. Published online ahead of print November 25, 2020: e1–e4. https://doi.org/10.2105/AJPH.2020.306036 )

Direct health care costs of hospital admissions due to adverse events in the Netherlands

2014 ◽  
Vol 24 (6) ◽  
pp. 1028-1033 ◽  
Author(s):  
Fabienne J. H. Magdelijns ◽  
Patricia M. Stassen ◽  
Coen D. A. Stehouwer ◽  
Evelien Pijpers
Keyword(s):  
Health Care ◽  
The Netherlands ◽  
Adverse Events ◽  
Health Care Costs ◽  
Hospital Admissions ◽  
Care Costs

scholarly journals Innovative technologies of wireless sensor network: The applications of WBAN system and environment

2019 ◽  
Vol 1 (2) ◽  
pp. 98-105
Author(s):  
Israa Al-Barazanchi ◽  
Haider Rasheed Abdulshaheed ◽  
Madya Safiah Binti Sidek
Keyword(s):  
Health Care ◽  
Sensor Node ◽  
Service Providers ◽  
Wireless Sensor ◽  
Body Area ◽  
Health Service Providers ◽  
Key Innovation ◽  
Patient Health ◽  
Life Threatening ◽  
Care Costs

Wireless Body Area Networks (WBAN) has risen as a key innovation for providing real-time patient health care and diagnosing many life-threatening diseases. The principle adopted by health service providers is providing convenience for patients in need of health care, allowing them comfortable of movement and constant monitoring with a reduction in health care costs.  In this study presented the basic concept and general background of the main WBAN system with applications. The current models for on-body and embedded WBANs, sensor node features, and sensor schemes for information via negation used in the WBAN.

scholarly journals Thiopurine Methyltransferase Enzyme Activity Determination before Treatment of Inflammatory Bowel Disease with Azathioprine: Effect on Cost and Adverse Events

2005 ◽  
Vol 19 (3) ◽  
pp. 147-151 ◽  
Author(s):  
Farzana A Sayani ◽  
Connie Prosser ◽  
Robert J Bailey ◽  
Philip Jacobs ◽  
Richard N Fedorak
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Adverse Events ◽  
Tpmt Activity ◽  
Thiopurine Methyltransferase ◽  
Target Dose ◽  
Inflammatory Bowel ◽  
Group 2 ◽  
Care Costs ◽  
Group 1

BACKGROUND: Azathioprine (AZA), used to treat inflammatory bowel disease (IBD), is metabolized by thiopurine methyltransferase (TPMT). The accumulation of individual metabolites varies because humans display genetic polymorphism for TPMT expression. Deficiencies in TPMT result in accumulation of toxic metabolites, followed by neutropenia and hepatic inflammation. Concern over acute toxicity frequently leads to under dosing and frequent monitoring tests and visits.OBJECTIVE: To determine whether assessment of TPMT activity before the administration of AZA would predict acute toxicity and, thus, allow for reductions in health care costs related to biochemical screening for, and management of, AZA-induced adverse events.METHODS: Before AZA treatment, 29 patients with IBD were prospectivelyrandomized to one of two groups: group 1, in which no TPMT assay was performed, was started on AZA at 1 mg/kg/day and then titrated every two weeks to a target dose of 2.5 mg/kg/day; and group 2, in which TPMT assays were performed, was started on AZA at the target dose of 2.5 mg/kg/day. For both groups, complete blood count and liver enzymes were monitored weekly for six weeks and at monthly intervals thereafter. Additional tests and health care interventions were undertaken at the discretion of the attending physicians.RESULTS: Of the 29 patients in the study, 15 were randomly assigned to group 1 and 14 to group 2. Demographics and disease activity were similar for both groups. Mean follow-up time was 7.1 months (range 3.5 to 10.7 months). Eight patients from group 1 and six patients from group 2 withdrew as a result of AZA-induced adverse events. There was no correlation between the TPMT activity and the development of AZA-induced adverse events. The direct health care costs for group 1 ($300.11 per patient) were lower than in group 2 ($348.87 per patient).CONCLUSION: The prospective assessment of TPMT enzyme activity before initiating AZA therapy in IBD patients incurred additional cost and did not predict AZA-induced toxicity.

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