Practical Psychopharmacology

2021 ◽  
Author(s):  
Joseph F. Goldberg ◽  
Stephen M. Stahl ◽  
Alan F. Schatzberg
Keyword(s):  
Primary Care Physicians ◽  
Healthcare Professionals ◽  
Neural Circuitry ◽  
Illustrative Case ◽  
Advanced Practice ◽  
Clinical Investigator ◽  
Clinical Presentations ◽  
Case Vignettes ◽  
Mind Set ◽  
User Friendly

Despite the lack of guidance available for practitioners, extensive polypharmacy has become the primary method of treating patients with severe and chronic mood, anxiety, psychotic or behavioral disorders. This ground-breaking new book provides an overview of psychopharmacology knowledge and decision-making strategies, integrating findings from evidence-based trials with real-world clinical presentations. It adopts the approach and mind-set of a clinical investigator and reveals how prescribers can practice 'bespoke psychopharmacology', tailoring care to the individualized needs of patients. Practitioners at all levels of expertise will enhance their ability to devise rationale-based treatments, targeting manifestations of dysfunctional neural circuitry and dimensions of psychopathology that cut across conventional psychiatric diagnoses. Presented in a user-friendly, practical, full-colour layout and incorporating summary tables, bullet points, and illustrative case vignettes, it is an invaluable guide for all healthcare professionals prescribing psychotropic medications, including psychiatry specialists, primary care physicians, and advanced practice registered nurses.

scholarly journals FRAM for Systemic Accident Analysis: A Matrix Representation of Functional Resonance

2018 ◽  
Vol 25 (01) ◽  
pp. 1850001 ◽  
Author(s):  
Patriarca Riccardo ◽  
Del Pinto Gianluca ◽  
Di Gravio Giulio ◽  
Costantino Francesco
Keyword(s):  
Traffic Management ◽  
Critical Role ◽  
Accident Analysis ◽  
Illustrative Case ◽  
Resonance Analysis ◽  
Linear Sequence ◽  
Illustrative Case Study ◽  
User Friendly ◽  
Runway Incursion

Due to the inherent complexity of nowadays Air Traffic Management (ATM) system, standard methods looking at an event as a linear sequence of failures might become inappropriate. For this purpose, adopting a systemic perspective, the Functional Resonance Analysis Method (FRAM) originally developed by Hollnagel, helps in identifying nonlinear combinations of events and interrelationships. This paper aims to enhance the strength of FRAM-based accident analyses, discussing the Resilience Analysis Matrix (RAM), a user-friendly tool that supports the analyst during the analysis, in order to reduce the complexity of representation of FRAM. The RAM offers a two-dimensional representation which systematically highlights the connections among couplings, and thus even the highly connected group of couplings. As an illustrative case study, this paper develops a systemic accident analysis for the runway incursion happened in February 1991 at LAX airport, involving SkyWest Flight 5569 and USAir Flight 1493. FRAM confirms itself a powerful method to characterize the variability of the operational scenario, identifying the dynamic couplings with a critical role during the event and helping in discussing the systemic effects of variability at different level of analysis.

P3769Rapid referral to a one-stop AF clinic following possible AF detection by community pharmacists leads to early diagnosis and appropriate anticoagulant treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Antoniou ◽  
L Barnett ◽  
J Craig ◽  
H Patel ◽  
T Lobban ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Community Pharmacy ◽  
Primary Care Physicians ◽  
Healthcare Professionals ◽  
Community Pharmacists ◽  
Long Term Conditions ◽  
Patient Consent ◽  
One Stop ◽  
Pulse Check

Abstract Background Atrial fibrillation is the most common cardiac arrhythmia globally, responsible for one third of ischaemic strokes, often resulting in death or incapacity. This condition, frequently asymptomatic is estimated to be up to 50% undiagnosed. Reducing this risk with appropriate detection and management strategies offers substantial economic and patient benefits. Community pharmacists have been shown to be an accessible healthcare professional capable of detecting atrial fibrillation. Concerns raised utilising community pharmacists is the additional workload for primary care physicians, and lack of a clear pathway to ensure patients are adequate followed with assurance of initiation of anticoagulation therapy. Purpose To assess the feasibility of screening by community pharmacists with onward referral to an innovative one-stop AF clinic to enable identification of new cases of AF and subsequent initiation of anticoagulation within 2 weeks. Methods 21 pharmacies were recruited and trained on pathophysiology of AF and demonstration of pulse taking using pulse check and Kardia mobile device. Any person walking into a community pharmacy aged ≥65 years was offered a free pulse check. For any irregularity detected, individualised counselling was offered with a referral made to a one-stop AF clinic for confirmation and initiation of anticoagulation. Written patient consent was obtained. Results 672 people were recruited with an average age of 69±3.5 years and 58% female (n=389). There was a history of hypertension in 618 (92%) and diabetes in 242 (36%), the most common co-morbidities. 45 people were referred following an irregular pulse or abnormal ECG rhythm strip, of whom 11 (1.6% of total population) had a confirmed AF diagnosis within 30 day follow up. An additional 8 cases with known AF not receiving anticoagulation termed (actionable AF) were also referred. All 19 cases of new or untreated AF were prescribed anticoagulation by the one stop clinic in accordance with guideline recommendations Conclusions ESC guidance recommends opportunistic screening for AF by pulse taking or ECG rhythm strip in patients ≥65 years of age. The 1.6% incidence of new AF was in accordance with meta-analyses identifying 1.4% of those aged ≥65 on a single time point check for presence of AF. Our model utilises the un-tapped skills of community pharmacy to deliver pulse checks of ECG rhythm recordings in an accessible primary care location with a clear referral pathway that is effective in early review and ensuring suitable patients receive anticoagulation. The innovative pathway could provide remote triage at scale and help address the missing people with undiagnosed and actionable AF by opening new channels for identification by healthcare professionals managing long term conditions who like pharmacists have not been considered suitable healthcare professionals due to lack of an established pathway for confirming the potential diagnosis of AF. Acknowledgement/Funding NHS England Test Bed Programme

Do-not-attempt-resuscitation (DNAR) orders: understanding and interpretation of their use in the hospitalised patient in Ireland. A brief report

2017 ◽  
Vol 44 (3) ◽  
pp. 201-203 ◽  
Author(s):  
Helen O’Brien ◽  
Siobhan Scarlett ◽  
Anne Brady ◽  
Kieran Harkin ◽  
Rose Anne Kenny ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Healthcare Professionals ◽  
Staff Nurses ◽  
University Teaching ◽  
Hard Copy ◽  
Do Not Resuscitate ◽  
Nasogastric Feeding ◽  
Care Plans ◽  
Hospital Doctors

Following the introduction of do-not-resuscitate (DNR) orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate (DNAR), decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5% (187/527), 19.8% (292/1477) in the nurses group but 68.8% (150/218) in the specialist nurses group and 40% (40/100) in the primary care physician group.Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences (p<0.001). Furthermore, a higher percentage of staff nurses (26.8%) and primary care physicians (22.5%) believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups (p<0.001). Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans.

Telemedicine for Patient Consultation: Factors affecting Use by Rural Primary-Care Physicians in Kansas

1995 ◽  
Vol 1 (3) ◽  
pp. 139-144 ◽  
Author(s):  
P Whitten ◽  
E A Franken
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Health Care Facilities ◽  
Telemedicine Service ◽  
Factors Affecting ◽  
Rural Primary Care ◽  
Referral Practices ◽  
Patient Consultation ◽  
Primary Care Practitioners ◽  
User Friendly

The purpose of our study was to investigate knowledge of, attitudes to, and use of interactive telemedicine for specialist consultation among rural practitioners in Kansas. We interviewed 28 rural primary-care practitioners at seven remote health-care facilities in six locations. Content analyses of the interviews showed universal but superficial knowledge of telemedicine, appreciation of the value of the technology, but relatively low usage of the telemedicine service available (32% of subjects). Physicians did not appear to be afraid of change. Telemedicine usage was not related to the professional characteristics of the physicians. Our findings suggest that further growth in the use of telemedicine will depend on efforts directed towards physicians which are aimed at creating a more user-friendly environment and at accommodating the referral practices of potential users.

scholarly journals Addressing Suicide Risk According to Different Healthcare Professionals in Spain: A Qualitative Study

2018 ◽  
Vol 15 (10) ◽  
pp. 2117 ◽  
Author(s):  
Juan-Luis Muñoz-Sánchez ◽  
María Sánchez-Gómez ◽  
María Martín-Cilleros ◽  
Esther Parra-Vidales ◽  
Diego de Leo ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
At Risk ◽  
Suicidal Behavior ◽  
Emergency Care ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
Healthcare Professionals ◽  
Main Concern ◽  
Patients At Risk

This study analyzes the views of four groups of healthcare professionals who may play a role in the management of suicidal behavior. The goal was to identify key factors for suicide prevention in different areas of the healthcare system. Qualitative research was conducted using focus groups made up of different healthcare professionals who participated in the identification, management, and prevention of suicidal behavior. Professionals included were primary care physicians, psychologists, psychiatrists, and emergency physicians. ‘Suicide’ was amongst the most relevant terms that came up in discussions most of the times it appeared associated with words such as ‘risk’, danger’, or ‘harm’. In the analysis by categories, the four groups of professionals agreed that interventions in at-risk behaviors are first in importance. Prevention was the second main concern with greater significance among psychiatrists. Primary care professionals call for more time to address patients at risk for suicide and easier access to and communication with the mental health network. Emergency care professionals have a lack of awareness of their role in the detection of risk for suicide in patients who seek attention at emergency care facilities for reasons of general somatic issues. Mental health care professionals are in high demand in cases of self-harm, but they would like to receive specific training in dealing with suicidal behavior.

scholarly journals Capacity Building of Health Professionals on Genetics and Genomics Practice: Evaluation of the Effectiveness of a Distance Learning Training Course for Italian Physicians

2021 ◽  
Vol 12 ◽  
Author(s):  
Giovanna Elisa Calabrò ◽  
Alessia Tognetto ◽  
Alfonso Mazzaccara ◽  
Donatella Barbina ◽  
Pietro Carbone ◽  
...  
Keyword(s):  
Distance Learning ◽  
Health Professionals ◽  
Primary Care Physicians ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Training Methods ◽  
Medical Discipline ◽  
Post Test ◽  
Genetics And Genomics

BackgroundThe rapid spread of personalized medicine requires professionals to manage the “omics revolution.” Therefore, the genetics/genomics literacy of healthcare professionals should be in line with the continuous advances in this field, in order to implement its potential implications for diagnosis, control and treatment of diseases. The present study investigates the effectiveness of a distance learning course on genetics and genomics targeted at medical doctors.MethodsIn the context of a project funded by the Italian Ministry of Health, we developed a distance learning course, entitled Genetics and Genomics practice. The course focused on genetic/genomics testing, pharmacogenetics and oncogenomics and was developed according to andragogical training methods (Problem-based Learning and Case-based Learning). We used a pre-test vs. post-test study design to assess knowledge improvement on a set of 10 Multiple Choice Questions (MCQs). We analyzed the proportion of correct answers for each question pre and post-test and the mean score difference stratified by gender, age, professional status and medical discipline. Moreover, the test was submitted to the participants 8 months after the conclusion of the course (follow-up), in order to assess the retained knowledge.ResultsThe course was completed by 1,637 Italian physicians, most of which were primary care physicians (20.8%), public health professionals (11.5%) and specialist pediatricians (10.6%). The proportion of correct answers increased in the post-test for all the MCQs. The overall mean score significantly increased, from 59.46 in the pre-test to 71.42 in the post-test (p &lt; 0.0001). The comparison in test performance between follow-up and pre-test demonstrated an overall knowledge improvement.ConclusionGenomics literacy among healthcare professionals is essential to ensure optimal translation to healthcare delivery of research. The results of this course suggest that distance-learning training in genetic/genomics practice represents an effective method to improve physicians’ knowledge in the immediate and mid-term time scale. A preprint version of this paper is available at: https://www.researchsquare.com/article/rs-10083/v1.

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