scholarly journals Clozapine antipsychotic polypharmacy: audit of use and patient monitoring

2013 ◽  
Vol 37 (10) ◽  
pp. 322-325 ◽  
Author(s):  
Sam Wilson ◽  
Ross Hamilton ◽  
John Callender ◽  
Angela MacManus ◽  
Sheila Howitt ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Patient Monitoring ◽  
Dose Range ◽  
Clinical Implications ◽  
High Dose ◽  
Antipsychotic Medications ◽  
Dose Monitoring ◽  
Wide Range

Aims and methodWe audited prescribing within our area to ascertain how widespread the practice of antipsychotic polypharmacy using clozapine was, and whether it was being carried out within existing standards, including those of high-dose monitoring when required.ResultsData on 169 patients were reviewed in year one, rising to 193 in year three. Around 30% of patients on clozapine received additional antipsychotic medication. A disturbingly low proportion of patients on clozapine whose antipsychotic polypharmacy brought them into the high-dose range were being monitored appropriately after three audit cycles (the proportion rose from 10% in cycle 1 to 28% in cycle 3). A wide range of additional antipsychotic medications was used.Clinical implicationsClozapine antipsychotic polypharmacy was prevalent at just below a third of all patients in this review. Prescribers should be alert to the fact that clozapine antipsychotic polypharmacy can push patients into the high-dose range and ensure appropriate monitoring.

scholarly journals Use of psychotropic medication in seven English psychiatric intensive care units

2010 ◽  
Vol 34 (4) ◽  
pp. 130-135 ◽  
Author(s):  
Steve Brown ◽  
Navjyoat Chhina ◽  
Stephen Dye
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antipsychotic Drug ◽  
Antipsychotic Medication ◽  
Psychotropic Medication ◽  
Intramuscular Injection ◽  
Case Note ◽  
Clinical Implications ◽  
High Dose ◽  
Prescribing Practices

Aims and methodTo describe the psychotropic medication given to 332 patients admitted consecutively to seven English psychiatric intensive care units (PICUs) by prospective, multicentre case-note analysis.ResultsOverall, 104 (32%) patients received rapid tranquillisation or zuclopenthixol acetate by intramuscular injection; 72 (23%) received more than one regular antipsychotic drug simultaneously. It was reported that 20 patients received high-dose antipsychotic medication, which was probably an underestimate. The use of these interventions varied significantly between different units.Clinical implicationsPotentially risky treatments such as forcible intramuscular medication are a standard part of PICU activity. Further work is needed to clarify the reasons behind the differences in prescribing practices between different PICUs.

scholarly journals Dose–Response of TLD-100 in the Dose Range Useful for Hypofractionated Radiotherapy

Dose-Response ◽  
2020 ◽  
Vol 18 (1) ◽  
pp. 155932581989408 ◽  
Author(s):  
Raffaele Liuzzi ◽  
Consiglia Piccolo ◽  
Vittoria D’Avino ◽  
Stefania Clemente ◽  
Caterina Oliviero ◽  
...  
Keyword(s):  
Dose Response ◽  
Radiation Treatment ◽  
Dose Range ◽  
Information Criterion ◽  
High Dose ◽  
Thermoluminescent Dosimeters ◽  
Dose Monitoring ◽  
Coefficients Of Variation ◽  
Best Fitting ◽  
Quadratic Models

Purpose: The aim of the study was to exploit the feasibility of thermoluminescent dosimeters (TLDs) in radiation therapy techniques in which high dose per fraction is involved. Methods: Dose–response of TLD-100 (LiF: Mg, Ti) was investigated in both 6-MV photon and 6-MeV electron beams. The element correction factor (ECF) generation method was applied to check the variability of the TLDs response. Two batches of 50 TLDs were divided into groups and exposed in the dose range 0 to 30 Gy. Regression analysis was performed with both linear and quadratic models. For each irradiation beam, the calibration curves were obtained in 3 dose range 0 to 8 Gy, 0 to 10 Gy, and 0 to 30 Gy. The best-fitting model was assessed by the Akaike Information Criterion test. Results: The ECF process resulted a useful tool to reduce the coefficients of variation from original values higher than 5% to about 3.5%, for all the batches exposed. The results confirm the linearity of dose–response curve below the dose level of 10 Gy for photon and electron beam and the supralinear trend above. Conclusion: The TLDs are suitable dosimeters for dose monitoring and verification in radiation treatment involving dose up to 30 Gy in a single fraction.

scholarly journals Monitoring patients on high-dose antipsychotics

1998 ◽  
Vol 22 (11) ◽  
pp. 671-674 ◽  
Author(s):  
Joan M. Barber ◽  
Jennifer Connaughton ◽  
Morag Wright
Keyword(s):  
Antipsychotic Medication ◽  
Consensus Statement ◽  
Journal Club ◽  
Clinical Implications ◽  
High Dose ◽  
Cardiac Events ◽  
Risk Avoidance ◽  
Similar Improvement ◽  
Prescribing Behaviour ◽  
New System

Aims and methodFollowing the publication of the 1994 Consensus Statement on the use of high-dose antipsychotic medication, we identified our high-dose patients and undertook an audit of the recommended physical investigations. The patients were identified by scrutiny of prescription records. Data were collected retrospectively at six-monthly intervals for four audit cycles. Results were fed back to clinicians at the hospital journal club.ResultsThe percentage of patients identified in the high-dose category fell from 35 to 23% over 18 months. Electrocardiograph monitoring of the group increased from 5 to 63%. Other tests showed a similar improvement. A very small number of abnormal results was shown. There were no untoward cardiac events.Clinical implicationsIntroduction of the standards of physical monitoring advised in the Consensus Statement has implications of cost to the NHS to be balanced against risk avoidance for patients. The number of abnormalities detected in our population was low. Changing prescribing behaviour in response to reported abnormal findings proved unexpectedly slow and a new system was required.

scholarly journals Review of antipsychotic prescribing at HMP/YOI Low Newton

2020 ◽  
pp. 1-7
Author(s):  
Lois Carey ◽  
Stephen Barlow
Keyword(s):  
Mental Health ◽  
Antipsychotic Medication ◽  
Best Practice ◽  
Psychotic Disorders ◽  
Psychotropic Medications ◽  
Clinical Implications ◽  
Mental Health Team ◽  
Antipsychotic Medications ◽  
Off Label ◽  
Health Team

Aims and Method The purpose of this review was to establish whether the prescription of antipsychotic medication in HMP Low Newton was safe, rational and consistent with current best practice. A search of the electronic healthcare records was performed on 14 March 2018 to identify all the women in the prison who were prescribed antipsychotic medication, and then data were collected from the records. Results A total of 46 out of 336 prisoners (13.7%) had been prescribed antipsychotic medications; 29 of the 46 patients (84.8%) were also prescribed other psychotropic medications at the same time. Quetiapine was the most frequently prescribed antipsychotic and was also the most likely to be prescribed for off-label indications. Less than one-third of all antipsychotic prescriptions were for psychotic disorders. Clinical implications The rationale for prescribing all antipsychotic medication, especially for off-label indications, should be clearly documented and reviewed regularly within the prison by the mental health team and psychiatrist.

scholarly journals The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 411-414 ◽  
Author(s):  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Harrington ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Clinical Implications ◽  
High Dose ◽  
Patient Factors ◽  
Younger Age ◽  
Patient Variables ◽  
Unexplained Variance ◽  
High Doses

Aims and MethodA1-day census, involving 3576 psychiatric in-patients prescribed antipsychotic medication, was conducted as a prelude to a multi-centre audit. The aim was to explore the extent to which a number of patient variables explain antipsychotic polypharmacy and the use of high doses of these drugs.ResultsPrescriptions of more than one type of antipsychotic drug were made for 50.5% of patients. Patient factors that influenced the probability of polypharmacy were: younger age, being male, detained under the Mental Health Act and on a rehabilitation or forensic ward, and a diagnosis of schizophrenia. The effect of ethnicity was not significant. Polypharmacy was the most powerful factor influencing the probability of being prescribed a high dose. Identified patient variables accounted for only 18% of the variance in dose prescribed.Clinical ImplicationsThe patient and clinician factors that account for the unexplained variance need to be identified.

scholarly journals A survey of in-patient and out-patient antipsychotic prescriptions in Hong Kong

2008 ◽  
Vol 32 (3) ◽  
pp. 103-105 ◽  
Author(s):  
Gabriel B. K. Hung ◽  
H. K. Cheung
Keyword(s):  
Hong Kong ◽  
Consensus Statement ◽  
Clinical Implications ◽  
High Dose ◽  
Prescription Data ◽  
Antipsychotic Medications ◽  
Legal Implications ◽  
Low Levels ◽  
High Doses ◽  
Almost All

Aims and MethodAntipsychotic prescriptions were analysed for a large sample of psychiatric in-patients and out-patients in Hong Kong. Case notes for patients receiving high doses were reviewed and compared with the most recent consensus statement issued by the Royal College of Psychiatrists.ResultsDemographic and prescription data were obtained from 1254 in-patients and 19 986 out-patients. Antipsychotic medications were prescribed to 1129 in-patients and 7520 out-patients, with 9.2% of in-patients and 1.8% of out-patients receiving a high dose. Almost all case notes failed to record the clinical indications for high-dose prescribing or that the patient had been informed. Electrocardiograms were performed in a very small proportion of patients receiving a high dose.Clinical ImplicationsLow levels of adherence to established guidelines for high-dose antipsychotic prescription were found in this study, with clinical and medico-legal implications. The results of this study highlight the need for staff education and regular audit of antipsychotic doses in the in-patient and out-patient setting.

scholarly journals High-dose antipsychotic treatment in clinical practice

1999 ◽  
Vol 23 (11) ◽  
pp. 661-664 ◽  
Author(s):  
Philip J. Tyson ◽  
Ann M. Mortimer ◽  
Jason A Wheeler
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Royal College ◽  
Treatment Compliance ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
High Dose ◽  
Dose Treatment ◽  
High Dose Treatment ◽  
High Doses

Aims and methodA trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.ResultsSixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.Clinical implicationsThe study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.

Novel study of using chitosan in gamma dose monitoring applications

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mohamad Bekhit ◽  
Essam Fahim ◽  
Asmaa Sobhy
Keyword(s):  
Color Change ◽  
Dose Range ◽  
Chitosan Film ◽  
Gamma Dose ◽  
High Dose ◽  
Ftir Analysis ◽  
Content Type ◽  
Pale Yellow ◽  
Dose Monitoring ◽  
Absorbed Doses

Purpose The purpose of this paper is to fall light on the possibility of using the biopolymer chitosan in gamma dose monitoring. Design/methodology/approach The chitosan films were irradiated to gamma rays in the range starting from 10 to 120 kGy at a dose rate of 1.4 kGy/h using 60Co gamma source. The ultra violet and visible (UV/Vis) spectrophotometry were used to examine the optical properties of chitosan film. Also, Fourier transform infrared (FTIR) analysis was used to detect and trace any change in structural bands that may take place upon irradiation. Findings Increase in optical density of the chitosan film was recorded at 298 nm that correlated with increasing in the absorbed doses. Change in color of the film from pale yellow to denser yellow was detected upon increasing the absorbed doses. The close investigation for UV/Vis and FTIR analysis nominates the chitosan film to be used as a label-dosimeter in the range of 10–120 kGy depending on chitosan concentrations. The chitosan film has an excellent stability in different environmental conditions with ±3.7% uncertainty in measurements (2σ, approximately equal to a 95% confidence level). Research limitations/implications Chitosan film may be used as a medium and high-dose monitor with an acceptable overall uncertainty in routine radiation processing Originality/value The useful dose range from 10 to 80 kGy was detected for different concentrations of chitosan (0.5, 1, 1.5 Wt%) that correlated with increasing the absorbed dose, which is assigned to the linear parts in the target response curves. For the dose range 10–120 kGy, the film may be used as label dosimeter with detected color change from pale yellow to dense yellow.

Morbidity and Mortality after High-dose Transfusion

2016 ◽  
Vol 124 (2) ◽  
pp. 387-395 ◽  
Author(s):  
Daniel J. Johnson ◽  
Andrew V. Scott ◽  
Viachaslau M. Barodka ◽  
Sunhee Park ◽  
Jack O. Wasey ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Dose Response ◽  
Dose Range ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
High Dose ◽  
Clinical Predictors ◽  
Response Curves ◽  
Wide Range ◽  
Very High

Abstract Background It is well recognized that increased transfusion volumes are associated with increased morbidity and mortality, but dose–response relations between high- and very-high-dose transfusion and clinical outcomes have not been described previously. In this study, the authors assessed (1) the dose–response relation over a wide range of transfusion volumes for morbidity and mortality and (2) other clinical predictors of adverse outcomes. Methods The authors retrospectively analyzed electronic medical records for 272,592 medical and surgical patients (excluding those with hematologic malignancies), 3,523 of whom received transfusion (10 or greater erythrocyte units throughout the hospital stay), to create dose–response curves for transfusion volumes and in-hospital morbidity and mortality. Prehospital comorbidities were assessed in a risk-adjusted manner to identify the correlation with clinical outcomes. Results For patients receiving high- or very-high-dose transfusion, infections and thrombotic events were four to five times more prevalent than renal, respiratory, and ischemic events. Mortality increased linearly over the entire dose range, with a 10% increase for each 10 units of erythrocytes transfused and 50% mortality after 50 erythrocyte units. Independent predictors of mortality were transfusion dose (odds ratio [OR], 1.037; 95% CI, 1.029 to 1.044), the Charlson comorbidity index (OR, 1.209; 95% CI, 1.141 to 1.276), and a history of congestive heart failure (OR, 1.482; 95% CI, 1.062 to 2.063). Conclusions Patients receiving high- or very-high-dose transfusion are at especially high risk for hospital-acquired infections and thrombotic events. Mortality increased linearly over the entire dose range and exceeded 50% after 50 erythrocyte units.

scholarly journals Polypharmacy and high-dose antipsychotics at the time of discharge from acute psychiatric wards

2011 ◽  
Vol 35 (8) ◽  
pp. 288-292 ◽  
Author(s):  
Tongeji E. Tungaraza ◽  
Uzma Zahid ◽  
Bhanumurthy Venkataramaiah
Keyword(s):  
Small Proportion ◽  
Psychiatric Ward ◽  
Clinical Implications ◽  
High Dose ◽  
National Formulary ◽  
Antipsychotic Medications ◽  
Acute Psychiatric Wards ◽  
High Doses ◽  
Acute Psychiatric Ward ◽  
Discharge Summaries

Aims and methodTo determine the extent of prescribed antipsychotic polypharmacy and high-dose antipsychotics at the time of discharge from an acute psychiatric ward. Copies of discharge summaries for patients between the ages of 18 and 65 were examined; only those that had antipsychotic medications at the time of discharge were included. Names and doses of antipsychotics and all other medications concurrently prescribed were recorded.ResultsA total of 651 discharge summaries were included in the study. Nearly a quarter of individuals were discharged on one antipsychotic as the only medication to take home; only 6.8% were discharged on a high-dose antipsychotic and of those on combinations 59.6% were on depot medications. Combining antipsychotics significantly predicted the use of high dose.Clinical implicationsMost patients were discharged on doses of antipsychotics within the British National Formulary limits; however, a small proportion is still sent home on high doses of antipsychotics. Combining antipsychotics remains the strongest predictor of high-dose antipsychotic use; clinicians need to be aware of this.

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