scholarly journals Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

2018 ◽  
Vol 43 (1) ◽  
pp. 8-16 ◽  
Author(s):  
Saeed Farooq ◽  
Abid Choudry ◽  
Dan Cohen ◽  
Farooq Naeem ◽  
Muhammad Ayub
Keyword(s):  
Side Effects ◽  
Review Of The Literature ◽  
Prescribing Practices ◽  
Treatment Resistant ◽  
Search Terms ◽  
Inadequate Knowledge ◽  
Mandatory Requirement ◽  
Significant Barrier ◽  
Prescription Rates ◽  
Training Programmes

Aims and methodTo systematically review the literature on barriers to the use of clozapine and identify any interventions for optimizing clozapine use in treatment-resistant schizophrenia. Journal databases were searched from 1972 to March 2018. The following search terms were used: treatment-resistant schizophrenia, clozapine, barriers, use, prescription rates, implementation, clozaril and prescribing practices. Following a review of the literature, 15 papers were included in the review.ResultsThe major barriers that were identified included mandatory blood testing, fear of serious side-effects and lack of adherence by the patients, difficulty in identifying suitable patients, service fragmentation, and inadequate training in or exposure to using clozapine.Clinical implicationsIn view of consistent evidence across the studies on inadequate knowledge and skills as a significant barrier, we suggest that a certification requiring competence in initiating and managing side-effects of clozapine becomes a mandatory requirement in training programmes.Declarations of interestNone.

Prescribing and Overprescribing

2017 ◽  
Author(s):  
Joel Paris
Keyword(s):  
Side Effects ◽  
Mental Disorders ◽  
Atypical Antipsychotics ◽  
Common Mental Disorders ◽  
Medical Science ◽  
Drug Combinations ◽  
Pharmacological Treatments ◽  
Treatment Resistant ◽  
Severe Mental Disorders ◽  
Prescription Rates

The development of effective pharmacological treatments for severe mental disorders between the 1950s and 1970s was one of the great triumphs of medical science. However, progress since then has been slow. Most drugs in current use are variants of those previously on the market, albeit with less worrisome side effects. Yet prescription rates have skyrocketed. Moreover, atypical antipsychotics, despite their side effects and warnings from watchdog organizations, are currently being widely used for sedation. Psychiatrists are prescribing these drugs for many, if not most, of their patients. All have a proper use—one cannot treat psychosis without antipsychotics. However, the situation in common mental disorders is different. Although antidepressants are essential in melancholic depressions, they are much less effective in mild to moderate cases. Moreover, protocols that advise drug combinations for “treatment-resistant” cases are not well based in evidence.

Long-term side effects following pneumonectomy: A case report and review of the literature

2019 ◽  
Author(s):  
BA Högerle ◽  
EL Bulut ◽  
L Klotz ◽  
F Eichhorn ◽  
M Eichhorn ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Review Of The Literature

Twitter Analysis of the Nonmedical Use and Side Effects of Methylphenidate, and User Sentiment about the Drug (Preprint)

2019 ◽  
Author(s):  
Jungu Kim ◽  
Su Cheol Kim ◽  
Jaegwon Jeong ◽  
Myeong Gyu Kim
Keyword(s):  
Side Effects ◽  
Social Networking ◽  
Brand Names ◽  
Social Networking Services ◽  
Hyperactivity Disorder ◽  
Search Terms ◽  
Nonmedical Use ◽  
Twitter Analysis ◽  
Sentiment Score ◽  
The Cost

BACKGROUND Methylphenidate, a stimulant used to treat attention deficit hyperactivity disorder (ADHD), has the potential for nonmedical uses such as study and recreation. In the era of active use of social networking services (SNSs), experience with the nonmedical use or side effects of methylphenidate might be shared on Twitter. OBJECTIVE To analyze monthly tweets about methylphenidate, its nonmedical use and side effects, and user sentiments about methylphenidate. METHODS Tweets mentioning methylphenidate from August 2018 to July 2019 were collected using search terms for methylphenidate and its brand names. Only tweets written in English were included. The monthly number of tweets about methylphenidate and the number of tweets containing keywords related to the nonmedical use and side effects of methylphenidate were analyzed. Precision was calculated as the number of true nonmedical use or side effects divided by the number of tweets containing each keywords. Sentiment analysis was conducted using the text and emoji in tweets, and tweets were categorized as very negative (less than -3), negative (-3 to -1), neutral (0), positive (1 to 3), or very positive (more than 3), depending on the sentiment score. RESULTS A total of 4,169 tweets were ultimately selected for analysis. The number of tweets per month was lowest in August (n=264) and highest in May (n=435). There were 292 (7.0%) tweets about nonmedical uses of methylphenidate. Among those, 200 (4.8%) described use for studying, and 15 (0.4%) described use for recreation. In 91 (2.2%) tweets, snorting methylphenidate was mentioned. Side effects of methylphenidate, mainly poor appetite (n=74, 1.8%) and insomnia (n=54, 1.3%), were reported in 316 (7.6%) tweets. The average sentiment score was 0.027 ± 1.475, and neutral tweets were the most abundant (n=1,593, 38.2%). CONCLUSIONS Tweets about methylphenidate were most abundant in May, mentioned nonmedical use for study or recreation, and contained information about side effects. Analysis of Twitter has the advantage of saving the cost and time needed to conduct a survey, and could help identify nonmedical uses and side effects of drugs.

scholarly journals MP018: Exercise prescription by Canadian emergency medicine physicians

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S72-S72
Author(s):  
M. Douglas-Vail ◽  
T. Bechamp ◽  
R. Soegtrop ◽  
M. Columbus ◽  
K. Wood ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Health Promotion ◽  
Exercise Prescription ◽  
Further Education ◽  
Preventative Medicine ◽  
Exercise Habits ◽  
Significant Barrier ◽  
Prescription Rates ◽  
Training Background ◽  
Drug And Alcohol

Introduction: Health promotion and disease prevention have been increasingly recognized as activities within the scope of emergency medicine. Exercise prescription by physicians has been shown to improve outcomes in obesity, cardiovascular disease, and many other diseases. An estimated 600,000 Canadians receive the majority of their care from emergency departments (ED), representing a substantial opportunity for health promotion. Our study examined the frequency of exercise prescription by emergency physicians (EPs) and determined factors that influence decisions to prescribe exercise. Methods: A national, confidential 22-item survey was distributed to Canadian EPs via email by the CAEP survey distribution protocol in November/December 2015. Demographics, exercise prescription rates and self-reported exercise habits were collected. Results: A total of 332 EPs responded. 92.4% of EPs reported being at least moderately active. 62.7% of EPs often or always council their patients about preventative medicine (smoking cessation, drug and alcohol use, diet and safe sex). However, only 23.8% often or always ask about their exercise habits. Even fewer (12.7%) often or always prescribe exercise. Training background significantly predicted level of comfort prescribing exercise. CCFP trained EPs were 5.1 (p = 0.001) times more likely than trained EPs to respond 'yes' they feel comfortable prescribing exercise, and 3.7 (p = .009) times more likely to respond 'sometimes'. CCFP (EM) trained EPs were 3.5 (p < 0.001) times more likely than trained EPs to respond 'yes' they feel comfortable prescribing exercise, and 2.0 (p = .031) times more likely to respond 'sometimes'. 76.1% of respondents believe that other EPs rarely or never prescribe exercise. Of respondents, only 36% feel comfortable prescribing exercise. The majority of EPs (73.4%) believe that the ED environment did not allow adequate time for exercise prescription. Conclusion: The majority of EPs council their patients regarding other forms of preventative medicine but few prescribe exercise to their patients. Available time in the ED was cited as a significant barrier to exercise prescription. CCFP trained EPs are more comfortable prescribing exercise, suggesting that their training may better educate and prepare them to council patients on exercise compared to trained EPs. Further education may be required to standardize an approach to prescribing exercise in the ED.

scholarly journals Experience with protein A-immunoadsorption in treatment-resistant adult immune thrombocytopenic purpura

Blood ◽  
1992 ◽  
Vol 79 (9) ◽  
pp. 2237-2245 ◽  
Author(s):  
HW Snyder ◽  
SK Cochran ◽  
JP Balint ◽  
JH Bertram ◽  
A Mittelman ◽  
...  
Keyword(s):  
Side Effects ◽  
Immune Thrombocytopenic Purpura ◽  
Protein A ◽  
Staphylococcal Protein A ◽  
Treatment Resistant ◽  
Thrombocytopenic Purpura ◽  
Specific Serum ◽  
Clinical Responses ◽  
Acute Increase

Abstract Extracorporeal immunoadsorption of plasma to remove IgG and circulating immune complexes (CIC) was evaluated as a therapy for adults with treatment-resistant immune thrombocytopenic purpura (ITP). Seventy-two patients with initial platelet counts less than 50,000/microL who had failed at least two other therapies were studied. They received an average of six treatments of 0.25 to 2.0 L plasma per procedure over a 2- to 3-week period using columns of staphylococcal protein A-silica (PROSORBA immunoadsorption treatment columns; IMRE Corp, Seattle, WA). The treatments caused an acute increase in the platelet count to greater than 100,000/microL in 18 patients and to 50,000 to 100,000/microL in 15 patients. The median time to response was 2 weeks. Responses were transient (less than 1 month duration) in seven of those patients (10%), but no additional relapses were reported over a follow- up period of up to 26 months (mean of 8 months). Clinical responses were associated with significant decreases in specific serum platelet autoantibodies (including anti-glycoprotein IIb/IIIa), platelet- associated Ig, and CIC. Thirty percent of treatments were associated with transient mild to moderate side effects usually presenting as a hypersensitivity-type reaction. Continued administration of failed therapies for ITP, which always included low-dose corticosteroids (less than or equal to 30 mg/d), had no demonstrable influence on the effectiveness of immunoadsorption treatment but did depress the incidence and severity of side effects. The degree of effectiveness of protein A immunoadsorption therapy in patients with treatment-resistant ITP is promising and further controlled studies in this patient population are warranted.

scholarly journals Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

2021 ◽  
Vol 6 ◽  
pp. 247275122110205
Author(s):  
Sebastian Rios ◽  
María Isabel Falguera-Uceda ◽  
Alicia Dean ◽  
Susana Heredero
Keyword(s):  
Survival Rate ◽  
Preoperative Planning ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

scholarly journals Comprehensive assessment of side effects associated with a single dose of ketamine in treatment-resistant depression

2020 ◽  
Vol 263 ◽  
pp. 568-575 ◽  
Author(s):  
Elia E. Acevedo-Diaz ◽  
Grace W. Cavanaugh ◽  
Dede Greenstein ◽  
Christoph Kraus ◽  
Bashkim Kadriu ◽  
...  
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Comprehensive Assessment ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

Treatment of Aggressive Behavior in Dementia With the Anticonvulsant Topiramate: A Retrospective Pilot Study

2003 ◽  
Vol 15 (3) ◽  
pp. 307-309 ◽  
Author(s):  
Benny Fhager ◽  
Inga-Maj Meiri ◽  
Magnus Sjögren ◽  
Åke Edman
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Side Effects ◽  
Aggressive Behavior ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Careful Treatment ◽  
And Training ◽  
Low Dosage

Aggressive behavior in dementia often has a severe impact on the quality of life of the patient and the caregivers, and is therefore important to handle. The strategy of treatment should be broad. Nonpharmacological interventions, including environmental adjustments and supporting and training the caregivers, should always be considered. Pharmacological treatment of aggressive behavior in patients with dementia often includes the use of neuroleptics. The atypical compounds clozapine, risperidone, and olanzapine have been shown to have an effect on aggressive behavior at low dosage with limited extrapyramidal side effects. The anticonvulsants carbamazepine and sodium valproate are further alternatives. In treatment-resistant cases, buspirone or lithium may be tried, although the effect of these substances on aggressive behavior in dementia has not been well established. In the end, however, a considerable degree of aggressive behavior sometimes remains after careful treatment trials, particularly in patients with severe aggressive behavior. In addition, treatment is sometimes limited by side effects.

Acute Renal Failure Caused by Imiquimod 5% Cream in a Renal Transplant Patient: Review of the Literature on Side Effects of Imiquimod

Dermatology ◽  
2011 ◽  
Vol 222 (2) ◽  
pp. 109-112 ◽  
Author(s):  
J. Santos-Juanes ◽  
A. Esteve ◽  
A. Mas-Vidal ◽  
P. Coto-Segura ◽  
E. Salgueiro ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Side Effects ◽  
Renal Transplant ◽  
Renal Transplant Patient ◽  
Transplant Patient ◽  
Review Of The Literature

Review of physical fitness, physiological demands and performance characteristics of jockeys

2021 ◽  
pp. 1-12
Author(s):  
K.A. Legg ◽  
D.J. Cochrane ◽  
E.K. Gee ◽  
C.W. Rogers
Keyword(s):  
Current Knowledge ◽  
Chronic Fatigue ◽  
Strength And Conditioning ◽  
Search Terms ◽  
Physiological Capacity ◽  
Movement Dynamics ◽  
Physiological Demands ◽  
And Performance ◽  
Training Programmes ◽  
Work Done

This narrative review collates data from different equestrian disciplines, both amateur and professional, to describe the physiological demands, muscle activity and synchronicity of movement involved in jockeys riding in a race and to identify limitations within our current knowledge. A literature search was conducted in Web of Science, Google Scholar, PubMed and Scopus using search terms related to jockeys, equestrian riders and their physiological demands, muscle use, movement dynamics and experience. Abstracts, theses and non-peer reviewed articles were excluded from the analysis. Jockeys work at close to their physiological capacity during a race. The quasi-isometric maintenance of the jockey position requires muscular strength and endurance, specifically from the legs and the core, both to maintain their position and adapt to the movement of the horse. Synchronous movement between horse and rider requires a coordinated activation pattern of the rider’s core muscles, resulting in less work done by the horse to carry the rider, possibly leading to a competitive advantage in race riding. Reports of chronic fatigue in jockeys demonstrate poor quantification of workload and recovery. The lack of quantitative workload metrics for jockeys’ limits calculation of a threshold required to reach race riding competency and development of sport-specific training programmes. Until the sport-specific demands of race riding are quantified, the development of evidence-based sport specific and potentially performance enhancing jockey strength and conditioning programmes cannot be realised.

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