scholarly journals Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

2017 ◽  
Vol 48 (10) ◽  
pp. 1616-1623 ◽  
Author(s):  
R. Patel ◽  
E. Chesney ◽  
M. Taylor ◽  
D. Taylor ◽  
P. McGuire
Keyword(s):  
Rate Ratio ◽  
Hospital Admissions ◽  
Incidence Rate Ratio ◽  
Psychiatric Inpatient ◽  
The Other ◽  
Paliperidone Palmitate ◽  
Before And After ◽  
Long Acting ◽  
Few Data ◽  
The Uk

AbstractBackgroundPaliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics.MethodsEHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.ResultsPatients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) −57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82).ConclusionPaliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.

scholarly journals Partial compliance with long-acting paliperidone palmitate and impact on hospitalization: a 6-year mirror-image study

2020 ◽  
Vol 10 ◽  
pp. 204512532092478 ◽  
Author(s):  
Sofia Pappa ◽  
Katy Mason
Keyword(s):  
Hospital Admissions ◽  
Mirror Image ◽  
Poor Compliance ◽  
Paliperidone Palmitate ◽  
Image Study ◽  
Partial Compliance ◽  
Before And After ◽  
The Mean ◽  
Oral Antipsychotic ◽  
Long Acting

Background: Previous studies showed a linear correlation between partial compliance with an oral antipsychotic medication and hospitalisation risk among patients with schizophrenia. Long-acting injections (LAIs) may significantly improve adherence and reduce relapse in patients with psychosis. The aim of this study was to evaluate the relationship between the level of compliance with 1-monthly paliperidone palmitate (PP1M) and hospitalisation rates. Methods: This was a naturalistic, mirror-image study examining retention, compliance and hospitalisation rates 3 years pre- and 3 years post-PP1M initiation. Compliance was divided in three groups: full (no missed dose/year), good (6–11injections/year), poor (<6 injections/year). Results: A total of 173 patients suffering from a severe mental illness (70% with a diagnosis of schizophrenia and 30% with other diagnoses) were included; 77% of patients continued PP1M for 1 year, 66% for 2 years and 55% for 3 years. Of the 95 patients who remained on PP1 throughout the 3 years of follow up, 81% showed full, 13% good, and only 6% poor compliance. In the patients who were fully compliant, the mean number of hospital admissions decreased from 1.34 to 0.43, and the mean number of bed days from 82 to 19 days per patient 3 years before and 3 years after PP1M initiation ( p < 0.001). It is noteworthy that the reductions in hospital stay were statistically significant for the group of patients with full compliance but not for the other two groups. In fact, patients with poor compliance demonstrated higher hospitalisation rates both before and after PPM1 initiation. These findings were similar in the subgroup of patients with schizophrenia who continued treatment for 3 years ( n = 68). Conclusion: There was a direct association between partial compliance and re-hospitalisation; fully compliant patients maintained the best outcomes in terms of reduced bed use following PPM1 initiation.

scholarly journals Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Karin Staaf ◽  
Anders Fernström ◽  
Fredrik Uhlin
Keyword(s):  
Cohort Study ◽  
Lower Risk ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
National Registry ◽  
The Other ◽  
Arteriovenous Fistulas ◽  
Cannulation Technique ◽  
Using Data ◽  
The Relationship

Abstract Background The four cannulation techniques, rope ladder (RL), area puncture (AP), buttonhole with blunt needles (BHb), and buttonhole with sharp needles (BHs), affects the arteriovenous fistula (AVF) in different ways. The aim of this study was to describe the relationship between the different cannulation techniques and the occurrence of AVF complications. Methods The study was performed as a national registry-based cohort study using data from the Swedish Renal Registry (SRR). Data were collected from January 2014 to October 2019. Seventy of Sweden’s dialysis units participate in the registry. We analyzed a total of 1328 AVFs in this study. The risk of complications was compared between the four different cannulation techniques. The risk of AVF complications was measured by the incidence and incidence rate ratio (IRR). We compared the IRRs of complications between different cannulation techniques. Results BHs is the most common cannulation technique in Sweden. It has been used in 55% of the AVFs at some point during their functional patency. BHb (29%), RL (13%), and AP (3%) has been used less. BHb had the lowest risk of complications compared to the other techniques, and a significantly lower risk of stenosis, infiltration, cannulation difficulties, compared to RL and BHs. Cannulation difficulties were significantly more common using AP compared to BHs, and BHb. Infections were not significantly increased using the buttonhole technique. Conclusions BHb had the lowest risk of complications. Infections were not significantly increased using the buttonhole technique. Dialysis units with a low infection rate may continue to use the buttonhole technique, as the risk of complications is lower.

scholarly journals Risk of invasive bacterial infections by week of age in infants: prospective national surveillance, England, 2010–2017

2019 ◽  
Vol 104 (9) ◽  
pp. 874-878 ◽  
Author(s):  
Shamez N Ladhani ◽  
Katherine L Henderson ◽  
Berit Muller-Pebody ◽  
Mary E Ramsay ◽  
Andrew Riordan
Keyword(s):  
Staphylococcus Aureus ◽  
National Health Service ◽  
Rate Ratio ◽  
Bacterial Infections ◽  
Incidence Rate Ratio ◽  
Age Distribution ◽  
The Other ◽  
National Surveillance ◽  
Group B ◽  
Prevalent Pathogen

ObjectiveTo estimate the incidence of laboratory-confirmed, invasive bacterial infections (IBIs) by week of age in infants over a 7-year period.DesignAnalysis of prospective national surveillance data for England.SettingNational Health Service hospitals in England.PatientsInfants aged <1 year who were hospitalised with IBI.Main outcome measuresIBI incidence by week of age, incidence rate ratio (IRR) at 8, 12 and 16 weeks compared with the first week of life, and the main pathogens responsible for IBI.ResultsThere were 22 075 IBI episodes between 2010/2011 and 2016/2017. The lowest annual cases were in 2011/2012 (n=2 799; incidence, 412/100 000 population), increasing year-on-year to 3 698 cases in 2016/2017 (incidence, 552/100 000 population). The incidence was highest in the first week of life and then declined rapidly. In 2016/2017, compared with the first week of life, weekly IBI incidence was 92% lower at 8 weeks (IRR 0.08; 95% CI 0.06 to 0.10) and 96% lower at 16 weeks of age (IRR 0.04; 95% CI 0.03 to 0.06). In 2016/2017, Escherichia coli was the most prevalent pathogen responsible for IBI (n=592, 16.0%), followed by group B Streptococci (n=493, 13.3%), Staphylococcus aureus (n=400, 10.8%) and Enterococci (n=304, 8.2%). The other pathogens were individually responsible for <5% of total cases. There were differences in age distribution of the pathogens with increasing age.ConclusionIBI incidence declines rapidly after the first week of life, such that infants have a very low risk of IBI by the time they are eligible for their routine immunisations from 8 weeks of age.

scholarly journals Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683 716 children

2019 ◽  
Vol 54 (3) ◽  
pp. 1802309 ◽  
Author(s):  
Michael Fleming ◽  
Catherine A. Fitton ◽  
Markus F.C. Steiner ◽  
James S. McLay ◽  
David Clark ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Hospital Admissions ◽  
Incidence Rate Ratio ◽  
Educational Interventions ◽  
Linkage Study ◽  
Increased Risk ◽  
Educational Need ◽  
Psychosocial Morbidity

BackgroundThe global prevalence of childhood asthma is increasing. The condition impacts physical and psychosocial morbidity; therefore, wide-ranging effects on health and education outcomes are plausible.MethodsLinkage of eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions and unemployment, provided data on 683 716 children attending Scottish schools between 2009 and 2013. We compared schoolchildren on medication for asthma with peers, adjusting for sociodemographic, maternity and comorbidity confounders, and explored effect modifiers and mediators.ResultsThe 45 900 (6.0%) children treated for asthma had an increased risk of hospitalisation, particularly within the first year of treatment (incidence rate ratio 1.98, 95% CI 1.93–2.04), and increased mortality (HR 1.77, 95% CI 1.30–2.40). They were more likely to have special educational need for mental (OR 1.76, 95% CI 1.49–2.08) and physical (OR 2.76, 95% CI 2.57–2.95) health reasons, and performed worse in school exams (OR 1.11, 95% CI 1.06–1.16). Higher absenteeism (incidence rate ratio 1.25, 95% CI 1.24–1.26) partially explained their poorer attainment.ConclusionsChildren with treated asthma have poorer education and health outcomes than their peers. Educational interventions that mitigate the adverse effects of absenteeism should be considered.

Disruptions to Abortion Care in Louisiana During Early Months of the COVID-19 Pandemic

2021 ◽  
pp. e1-e9
Author(s):  
Sarah C. M. Roberts ◽  
Nancy F. Berglas ◽  
Rosalyn Schroeder ◽  
Mary Lingwall ◽  
Daniel Grossman ◽  
...  
Keyword(s):  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Service Availability ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Abortion Care ◽  
Before And After ◽  
Second Trimester Abortion ◽  
Service Data ◽  
Abortion Clinics

Objectives. To examine changes in abortions in Louisiana before and after the COVID-19 pandemic onset and assess whether variations in abortion service availability during this time might explain observed changes. Methods. We collected monthly service data from abortion clinics in Louisiana and neighboring states among Louisiana residents (January 2018–May 2020) and assessed changes in abortions followin pandemic onset. We conducted mystery client calls to 30 abortion clinics in Louisiana and neighboring states (April–July 2020) and examined the percentage of open and scheduling clinics and median waits. Results. The number of abortions per month among Louisiana residents in Louisiana clinics decreased 31% (incidence rate ratio = 50.69; 95% confidence interval [CI] = 50.59, 0.79) from before to after pandemic onset, while the odds of having a second-trimester abortion increased (adjusted odds ratio [AOR] = 51.91; 95% CI = 51.10, 3.33). The decrease was not offset by an increase in out-of-state abortions. In Louisiana, only 1 or 2 (of 3) clinics were open (with a median wait >.2 weeks) through early May. Conclusions. The COVID-19 pandemic onset was associated with a significant decrease in the number of abortions and increase in the proportion of abortions provided in the second trimester among Louisiana residents. These changes followed service disruptions. (Am J Public Health. Published online ahead of print June 29, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306284 )

Twenty-four months experience of paliperidone long-acting injection in a Spanish psychiatric service: A mirror image analysis

2016 ◽  
Vol 33 (S1) ◽  
pp. S541-S541
Author(s):  
C. Gómez Sánchez-Lafuente ◽  
R. Reina Gonzalez ◽  
F. Moreno De Lara ◽  
A. De Severac Cano ◽  
E. Mateos Carrasco ◽  
...  
Keyword(s):  
Image Analysis ◽  
Psychiatric Service ◽  
Psychiatric Inpatient ◽  
Previous Treatment ◽  
Mirror Image ◽  
Oral Medication ◽  
Common Reason ◽  
Paliperidone Palmitate ◽  
Long Acting ◽  
Randomised Controlled

IntroductionLack of adherence is a common cause of relapse in schizophrenia. Long-acting antipsychotics have shown in recent studies that they improve compliance. However, some randomised controlled trials showed no difference in relapse rates between oral medication and long-acting injections.ObjectiveTo report the use of paliperidone palmitate in an Acute Psychiatrist Unit in Spain.MethodRetrospective observational study of 42 patients prescribed paliperidone palmitate (PLAI) during an admission at Acute Psychiatric unit in Málaga. In the mirror image analysis, the main outcome measure was the total number of days of psychiatric inpatient care twelve months before and after patients started Paliperidone palmitate.ResultsMost common reason for starting paliperidone palmitate was lack of adherence to oral medication (54%) followed by lack of efficacy on previous medication (31%). Olanzapine (47%) and risperidone (41%) were most commonly antipsychotics prescribed before PLAI. Thirty-four patients continued PLAI over twelve months (80%). Poor compliance was the most common reason of withdrawal. Three patients had a movement disorder adverse effect. Only one was lost because adverse effects. Total admissions and inpatients days were significantly reduced from the previous treatment to PLAI-treatment period (Table 1).ConclusionPLAI was associated with a reduction in total inpatient days. The financial saving from reduced admissions stays exceeded the acquisition and administration cost of PLAI. Improved compliance because of PLAI is the most plausible explanation of this result (Fig. 1).Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Dermal Filler

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Ferra O. Mawu
Keyword(s):  
Informed Consent ◽  
Side Effects ◽  
The Body ◽  
The Other ◽  
Dermal Filler ◽  
Dermal Fillers ◽  
Before And After ◽  
Long Acting ◽  
Good Preparation ◽  
The Ideal

Abstract: Dermal filler is a non-surgical procedure to improve facial volume or the anatomy of other parts of the body. It is also a rejuvenate therapy to achieve a younger appearance. Besides that, the need of lipodystrophy therapy is increasing. There are several types of fillers with their superiorities and inferiorities; therefore, it is pretty difficult to determine and choose the ideal filler. Dermal fillers vary in duration of therapeutic effect, filler technique, filler origin, and their physical properties. To date, there is no perfect filler so far. An ideal filler must be non-allergenic, non-carcinogenic, non-teratogenic, as well as has achievable cost and long acting effect. In case that dermal filler is therapeutical indicated, good preparation of doctor and patient is essentially needed. Consultation and information have to cover the therapy indication, filler technique, filler limitation, side effects, outcome, cost, and informed consent. As the other cosmetic procedures, to achieve optimal satis-faction, the doctor must be able to provide effective communication to the patient before and after the dermal filler therapy.Keywords: dermal fillerAbstrak: Dermal filler adalah prosedur non-bedah untuk penambahan volume wajah atau anatomi tubuh lainnya. Prosedur ini juga merupakan salah satu terapi rejuvenasi yang bertujuan untuk tampilan lebih muda. Selain itu, kebutuhan untuk terapi lipodistrofi juga makin meningkat. Terdapat berbagai jenis filler dengan keunggulan dan kekurangaood prepnnya masing-masing, sehingga agak sulit menentukan atau memilih produk filler yang ideal. Dermal filler bervariasi dalam hal lamanya efek terapi yang diperoleh, cara pemberian, asal filler, dan sifat fisiknya. Sampai saat ini tidak ada produk filler yang sempurna. Untuk menjadi ideal, produk filler harus nonalergenik, nonkarsinogenik, nonteratogenik, harga terjangkau dan berefek terapi yang panjang. Saat dermal filler menjadi pilihan terapi atau tindakan, persiapan yang tepat baik dokter maupun pasien merupakan hal yang esensial. Konsultasi dan informasi harus meliputi ketepatan indikasi pemberian filler, tehnik pemberian, keterbatasan filler, efek samping, kemungkinan hasil akhir, biaya, dan informed consent. Sebagaimana prosedur kosmetik lainnya, untuk kepuasan bersama, dokter harus mampu dan bersedia memberikan komunikasi efektif kepada pasien sebelum dan sesudah terapi dermal filler.Kata kunci: dermal filler

scholarly journals Psychoeducation and motivational interviewing to reduce relapses and increase patients’ involvement in antipsychotic treatment: interventional study

2020 ◽  
Vol 44 (6) ◽  
pp. 265-268
Author(s):  
Gabriella Bröms ◽  
Lindah Cahling ◽  
Anders Berntsson ◽  
Lars Öhrmalm
Keyword(s):  
Motivational Interviewing ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Control Group ◽  
Antipsychotic Treatment ◽  
Clinical Implications ◽  
Interventional Study ◽  
Before And After ◽  
Long Acting

Aims and methodTo assess whether the combination of motivational interviewing and psychoeducation affects relapse rate and stimulates involvement of people with psychosis in their treatment. We conducted an interventional study including patients with schizophrenia or schizoaffective disorder treated with oral antipsychotics, without previous experience of long-acting injectable antipsychotics (LAIs). They were randomised to either psychoeducation with motivational interviewing or a control group. Hospital admissions 18 months before and after the intervention, and switches to LAIs 18 months after the intervention, were recorded.ResultsThe two groups each comprised 101 participants. Fourteen from the intervention group and seven from the control group switched to LAIs. Five in the intervention group instigated the switch themselves, compared with zero controls (P = 0.06). Fourteen in the intervention group were readmitted to hospital during follow-up, compared with 23 in the control group (P = 0.14).Clinical implicationsPsychoeducation with motivational interviewing may increase patients' involvement in their treatment and reduce the relapse frequency.

scholarly journals Kin-based alloparenting and infant hospital admissions in the UK Millennium cohort

2020 ◽  
Vol 2020 (1) ◽  
pp. 72-81 ◽  
Author(s):  
David Waynforth
Keyword(s):  
Infectious Diseases ◽  
Day Care ◽  
Rate Ratio ◽  
Infant Health ◽  
Incidence Rate Ratio ◽  
Work Hours ◽  
Alloparental Care ◽  
The Difference ◽  
The Uk ◽  
Infant Hospitalization

Abstract Background and objectives Kin-selected altruism is an evolutionary explanation for why biological kin other than parents are willing childcare providers or alloparents. Kin alloparents may increase lineage fitness by reducing maternal energy depletion and improving child survival through childcare activities. The aim of this research was to apply the hypothesis that kin-based alloparental care has benefits for child health in a western, educated, industrialized, rich, democratic context. Methodology The hypothesis was tested using the first sweep of the UK Millennium Cohort Study (n = 18 552 infants). The outcome was number of hospitalizations by age 9 months, and the main predictors were kin-based alloparental care during work hours, socioeconomic position and infant health-related variables and their interactions with kin-based alloparenting. Analysis of hospitalizations was carried out using negative binomial regression. Results Kin alloparents were primary day carers in 17% of households. Infants whose main care arrangement during work hours was with kin allocarers had statistically significantly fewer hospitalizations than infants in all other care arrangements combined (Incidence rate ratio = 0.86, P &lt; 0.03), and when contrasted with maternal day care (Incidence rate ratio = 0.79, P &lt; 0.02). Conclusions and implications Kin-based allocare was associated with about a 15% reduction in the risk of infant hospitalization in the first 9 months. The difference appeared to be due in part to a difference in the risk of hospitalization for infectious diseases. Sensitivity analyses indicated that infants cared for by their mother during the day rather than in day-care facilities were most at risk of hospitalization compared with those in kin-based care. Lay summary Modern industrialized societies are generally characterized by nuclear family households, with grandparents and other extended family often living a considerable distance away. Studies carried out in societies which have not undergone the fragmentation of extended families have shown that grandmothers and other biological kin reduce infant mortality, most likely because they distribute the burden of infant care so that it does not fall exclusively on the mother. Here, the hypothesis that grandparental and other family care would be beneficial for infant health in the contemporary UK was testing using the UK Millennium cohort. Infant health was measured as number of hospitalizations in the first 9 months from birth. The main findings were that kin-based infant care, which was most commonly by grandparents, was associated with a 15% reduction in the risk of hospitalization in infants up to 9 months of age. Further analysis suggested that the difference was larger for risk of infant hospitalization due to infectious diseases rather than non-infectious diseases. The results also suggested that the finding may have been driven by increased risk for infants of mothers caring for their infant during normal working hours with no other help, such as from the father or pay-for day-care.

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