scholarly journals Tackling constipation in patients on high dose antipsychotics

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S134-S134
Author(s):  
Sandhya Eappen
Keyword(s):  
Fruits And Vegetables ◽  
Bowel Function ◽  
Risk Profile ◽  
Fecal Impaction ◽  
Care Plan ◽  
High Dose ◽  
Early Management ◽  
Meal Plan ◽  
Ward Rounds ◽  
Vigorous Treatment

AimsThe aim of this audit was to look into patients on high dose antipsychotics who had developed complications of constipation in the PICU setting .BackgroundAntipsychotics are usually used in the treatment of Schizophrenia and other psychotic illnesses. Drug such as Clozapine mainly has a higher risk profile due to gastrointestinal hypo motility. It could present as constipation, fecal impaction or a bowel obstruction and could even lead to death.MethodDuring ward rounds enquired on bowel habits and diet.Physical examination of patients complaining of abdominal pain.Screened notes in past to see how many patients complained of constipation and interventions suggested and used.I65.Result3 of the 10 patients on PICU were on high dose antipsychotics and 2 of them had reported constipation. Of which one required daily review and vigorous treatment with laxatives and dietary changes.RecommendationBristol stool chart introduced as part of care plan for all patients.Teaching presentation of constipation and its treatment management was given to the PICU team.Involving medical team early on for assessment and prophylactic laxatives prescription.Liaison with the pantry team to include more options of fruits and vegetables into daily meal plan for patients.Data and material handed over to next trainee to Re-audit and complete audit cycle.ConclusionAppropriate prevention and early management of side effects can enhance the benefits of antipsychotics. Bowel function monitoring and the use of prophylactic laxatives for patient on high dose antipsychotics such as clozapine is advisable to prevent complications related to it.

scholarly journals Development and implementation of a structured ward round in acute adult psychiatry

2018 ◽  
Vol 7 (3) ◽  
pp. e000035 ◽  
Author(s):  
Anna Rebecca Mattinson ◽  
Sarah Jane Cheeseman
Keyword(s):  
Improve Patient Safety ◽  
Quality Care ◽  
General Medicine ◽  
Multidisciplinary Care ◽  
Ward Round ◽  
Care Plan ◽  
Care Plans ◽  
Adult Psychiatry ◽  
Paired Male ◽  
Ward Rounds

Delivering high quality care in acute psychiatry requires a coordinated approach from a multidisciplinary team (MDT). Weekly ward rounds are an important forum for reviewing a patient’s progress and developing a personalised care plan for the coming week. In general medicine, structured ward rounds and check lists have been shown to prevent omissions and improve patient safety; however, they are not widely used in psychiatry. At the Royal Edinburgh Hospital, the format of ward rounds differed between psychiatry wards and clinical teams, and care plans were not standardised. An audit in October 2015 found only 5% of acute psychiatric inpatients had a documented nursing care plan. It was agreed that a clear multidisciplinary care plan from the weekly ward round would be beneficial. A group of consultant psychiatrists identified seven key domains for ward round (Social needs, Community Mental Health Team liaison, Assessments required, Mental Health Act, Prescriptions: medication electroconvulsive therapy (ECT), T2/T3, Engagement with relatives and carers, Risk Assessment and Pass Plans). This was given the acronym SCAMPER. Following this, a clinical MDT on a paired male and female ward, developed and introduced a structured ward round sheet. Within 8 weeks this was being used for 100% of patients. It was subsequently introduced into three other acute adult psychiatry wards and the intensive psychiatric care unit. Staff feedback was sought verbally and via a questionnaire. This was positive. The form was widely accepted and staff felt it improved patient care and ward round quality.

scholarly journals Behavioural and Anthropometric Profile of Reproductive Age Women Admitted with Cardiovascular Diseases in the Capital City of Bangladesh

2016 ◽  
Vol 4 (2) ◽  
pp. 10-15
Author(s):  
Zannatul Ferdusi ◽  
Samira Humaira Habib ◽  
GU Ahsan ◽  
Nazneen Akhter ◽  
Ariful Bari Chowdhuri ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Physical Exercise ◽  
Smokeless Tobacco ◽  
Fast Food ◽  
Fruits And Vegetables ◽  
Risk Profile ◽  
Reproductive Age ◽  
Reproductive Age Women ◽  
Fatty Food ◽  
The Mean

Background and Objectives: Studies have shown that the risk profile of cardiovascular diseases for women of reproductive age is not the same as that of postmenopausal women. The risk profile of women of reproductive age group in our country has not been well studied. The present study was intended to investigate the risk profile and risk behaviour of reproductive age women for cardiovascular diseases. Materials and Methods: This cross-sectional study, intended to assess the risk factors of cardiovascular diseases among reproductive age women (ranging from 15 - 49 years), was conducted on women with cardiovascular diseases admitted at two selected Cardiac Specialized Hospitals of Dhaka city. A total of 223 women with predefined eligibility criteria were included in the study. The study investigated the details of the socio-demographic, behavioural, anthropometric and biochemical characteristics of the sampled population. Result: More than two-fifth of the respondents belonged to age group 35-45 years. A few (1.3%) respondents were currently smoker. But over 8% were used to consuming smokeless tobacco (betel-nut with zorda, gul etc.) and 12.6% were occasional consumer. The mean duration of smokeless tobacco consumption was 14.1 ± 10.6 years and the mean frequency of consumption of smokeless tobacco was 3.6 ± 2.3 per day. More than one-third of the respondents (35.90/0) were overweight and 15.7% were obese. The mean BMI of the respondents was 23.8 ± 4.8 kg/m2. The mean waist and hip circumferences were 98.9 ± 17 and 99.9 ± 12.2 cm respectively. Majority (89.7%) of the women's waist:hip ratio was at risk. The recommended fruit and vegetables intake (at least 5 servings a day) by the respondents was not found at all. Over half (50.2%) of the respondents were used to regular intake of extra table salt in their meals, 19.3% were occasional user. Nearly one-fifth of the respondents (17.9%) used to have fast food and the mean number of intake was 1.5±1 per day in a usual week. Over one-quarter (27.4%) of the respondents reported maintaining recommended physical exercise (minimum 30 min of physical exercise for at least 5 days a week). About 40% were hypertensive. Nearly two-thirds (62.3%) had the family history of chronic diseases; of them approximately 55% reported hypertension, 51.4% heart disease and diabetes mellitus. Conclusion: The women in general took inadequate fruits and vegetables. One-third of women were accustomed to fast food, street food, fatty-food etc. Every 1 in 16 women was used to consuming smokeless tobacco. Only one-third took recommended physical exercise. The rapidly increasing trend of obesity might be due to sedentary life-style with increased consumption of fatty-food and less intake of fruits and vegetables. Further investigation with large sample is recommended to validate the findings of the present study. Ibrahim Cardiac Med J 2014; 4(2): 10-15

scholarly journals Opioid-induced constipation in patients with cancer pain in Japan (OIC-J study): a post hoc subgroup analysis of patients with lung cancer

2020 ◽  
Author(s):  
Hisao Imai ◽  
Soichi Fumita ◽  
Toshiyuki Harada ◽  
Toshio Noriyuki ◽  
Makio Gamoh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Pain ◽  
Diagnostic Criteria ◽  
Bowel Function ◽  
Early Management ◽  
Patients With Cancer ◽  
Bowel Movements ◽  
Post Hoc

Abstract Objective To evaluate the opioid-induced constipation burden in the subgroup of patients with lung cancer who participated in the observational Opioid-Induced Constipation in Patients with Cancer Pain in Japan (OIC-J) study. Methods The prospective, observational study, OIC-J, included 212 patients with various tumour types, 33% of whom had lung cancer. The incidence of opioid-induced constipation was evaluated using several diagnostic criteria, as well as the physician’s diagnosis and patient’s subjective assessment. Following initiation of opioids, patients recorded details of bowel movements (i.e. date/time, Bristol Stool Scale form, sensations of incomplete evacuation or anorectal obstruction/blockage and degree of straining) in a diary for 2 weeks. Relationships between patient characteristics and opioid-induced constipation onset and effects of opioid-induced constipation on quality of life were explored. Results In total, 69 patients were included in this post hoc analysis. The incidence of opioid-induced constipation varied (39.1–59.1%) depending on which diagnostic criteria was used. Diagnostic criteria that included a quality component or a patient’s feeling of bowel movement as an evaluation item (i.e. Rome IV, physician’s diagnosis, Bowel Function Index, patient’s assessment) showed higher incidences of opioid-induced constipation than recording the number of spontaneous bowel movements alone. Opioid-induced constipation occurred rapidly after initiating opioids and had a significant impact on Patient Assessment of Constipation Symptoms total score (P = 0.0031). Patient baseline characteristics did not appear to be predictive of opioid-induced constipation onset. Conclusions In patients with lung cancer, opioid-induced constipation can occur quickly after initiating opioids and can negatively impact quality of life. Early management of opioid-induced constipation, with a focus on quality-of-life improvement and patient’s assessments of bowel movements, is important for these patients.

scholarly journals Effects of carrot and tomato juice consumption on faecal markers relevant to colon carcinogenesis in humans

2008 ◽  
Vol 99 (3) ◽  
pp. 606-613 ◽  
Author(s):  
Kerstin Schnäbele ◽  
Karlis Briviba ◽  
Achim Bub ◽  
Silvia Roser ◽  
Beatrice L. Pool-Zobel ◽  
...  
Keyword(s):  
Fruits And Vegetables ◽  
Colon Adenocarcinoma ◽  
Colon Carcinogenesis ◽  
Tomato Juice ◽  
High Dose ◽  
Carrot Juice ◽  
Cell Culture Systems ◽  
Adenocarcinoma Cells ◽  
Water Ph ◽  
Β Carotene

High intakes of carotenoid-rich fruits and vegetables are associated with a reduced risk of various cancers including colon cancer. A human intervention study with carrot and tomato juice should show whether a diet rich in carotenoids, especially high in β-carotene and lycopene, can modify luminal processes relevant to colon carcinogenesis. In a randomised cross-over trial, twenty-two healthy young men on a low-carotenoid diet consumed 330 ml tomato or carrot juice per d for 2 weeks. Intervention periods were preceded by 2-week depletion phases. At the end of each study period, faeces of twelve volunteers were collected for chemical analyses and use in cell-culture systems. Consumption of carrot juice led to a marked increase of β-carotene and α-carotene in faeces and faecal water, as did lycopene after consumption of tomato juice. In the succeeding depletion phases, carotenoid contents in faeces and faecal water returned to their initial values. Faecal water showed high dose-dependent cytotoxic and anti-proliferative effects on colon adenocarcinoma cells (HT29). These effects were not markedly changed by carrot and tomato juice consumption. Neither bile acid concentrations nor activities of the bacterial enzymes β-glucosidase and β-glucuronidase in faecal water changed after carrot and tomato juice consumption. Faecal water pH decreased only after carrot juice consumption. SCFA were probably not responsible for this effect, as SCFA concentrations and profiles did not change significantly. In summary, in the present study, 2-week interventions with carotenoid-rich juices led only to minor changes in investigated luminal biomarkers relevant to colon carcinogenesis.

Early Management and Decision Making for the Treatment of Myelomeningocele

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 450-458 ◽  
Author(s):  
Richard H. Gross ◽  
Alan Cox ◽  
Ruth Tatyrek ◽  
Michael Pollay ◽  
William A. Barnes
Keyword(s):  
Supportive Care ◽  
Early Selection ◽  
Early Management ◽  
Ethical Concerns ◽  
University Of Oklahoma ◽  
Legal Custody ◽  
Oklahoma Health ◽  
The University ◽  
Vigorous Treatment

A program for early selection and treatment of the infant with myelomeningocele was developed at the University of Oklahoma Health Sciences Center in 1977. Over a 5-year period, 69 babies were evaluated, 36 babies were recommended for early vigorous treatment. Of the 33 babies for whom only supportive care was recommended, five were initially treated at the parents' request, two underwent delayed vigorous treatment, one was subsequently treated by "crisis management," one moved and did not return for follow-up, and 24 received only supportive care. All 24 babies died between 1 to 189 days of age (mean 37 days). The involvement of several physicians and paramedical support personnel is considered essential for this approach of early selection and treatment. Continued support and regular follow-up is necessary for any baby who receives only supportive care. Parents retain legal custody. Although ethical concerns make any approach difficult, the method presented is considered to be the best alternative available at this time.

DNMT3A Mutations In AML: Incidence, Prognostic Influence and Association With Other Molecular Markers

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2627-2627
Author(s):  
Igor Wolfgang Blau ◽  
Rimma Berenstein ◽  
Claudia D. Baldus ◽  
Sophie Schlabitz ◽  
Asiye Kar ◽  
...  
Keyword(s):  
Dna Methyltransferase ◽  
Median Overall Survival ◽  
Conflicts Of Interest ◽  
Direct Sequencing ◽  
Risk Profile ◽  
High Dose ◽  
Intermediate Risk ◽  
Recurrent Mutations ◽  
Idh1 And Idh2 Mutations ◽  
Highly Correlated

Abstract Abnormal epigenetic regulation has been implicated in oncogenesis. Mutations in the DNA methyltransferase 3A (DNMT3A) gene were recently demonstrated in acute myeloid leukemia (AML) as a candidate for the initiating of lesions in AML with adverse clinical outcome. Using direct sequencing, identification of the DNMT3A mutations was done in 320 AML patients. Additionally, we analyzed NPM1, FLT3-ITD, FLT3-D835, IDH1 and IDH2 mutations by PCR and DNA sequencing. The retrospective analysis of diagnostic bone marrow samples was performed in AML patients treated in our institution. In all AML patients double induction therapy containing of “7+3” therapy followed by 4 cycles of high dose AraC consolidation was implicated in accordance with therapeutic standards of our institution. We identified DNMT3A mutations in 22% of AML patients. The most common of mutations affect amino acid R822 in exon 23. The DNMT3A mutation was highly enriched in the group of patients with intermediate-risk profile (35%, P<0.01). Unlikely FLT3, DNMT3A mutations were absent in all AML patients with favorable-risk group (P<0.001). AML patients with DNMT3A mutations were older (P=0.05), had higher WBC and platelet counts (P=0.02 for both comparison) and higher relapse rate (P=0.01). The median overall survival among AML patients with DNMT3A mutations was significantly shorter than among patients without such mutation (13.3 months versus 31.3 months, P<0.01). Occurrence of DNMT3A mutations was associated with presence of other common mutations, such as NPM1, FLT3-ITD, FLT3-D835, IDH1 and IDH2. Correlations of the DNMT3A mutations with NPM1 and FLT3-ITD mutations were significant (P<0.001). Our results indicate that DNMT3A mutations are highly recurrent in AML patients with intermediate-risk profile. DNMT3A mutations are highly correlated with NPM1/FLT3-ITD mutations and are associated with an unfavorable prognosis. The discovery of recurrent mutations in DNMT3A gene may provide a new prognostic marker for the risk stratification for AML patients. Disclosures: No relevant conflicts of interest to declare.

The National Cancer Data Base report on the utilization of an adjuvant immunotherapy in stage III melanoma in relation to age.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19000-e19000
Author(s):  
Arden Fredeking ◽  
Suraj S. Venna ◽  
Sekwon Jang
Keyword(s):  
Data Base ◽  
Age Groups ◽  
National Cancer Data Base ◽  
Older Age ◽  
Stage Iii ◽  
Care Plan ◽  
High Dose ◽  
Adjuvant Immunotherapy ◽  
Cancer Data ◽  
Stage Iii Melanoma

e19000 Background: The 5-year survival of Stage III melanoma ranges from 30-70%. High dose interferon alfa-2b (IFN) is an adjuvant immunotherapy approved in 1995 for stage III melanoma, however, its use has been limited by its significant toxicity and modest benefit. We hypothesized the utilization of adjuvant immunotherapy is less in older age group compared to younger patients. Methods: Using the National Cancer Data Base (NCDB) aggregate data, demographic, socioeconomic, insurance information, and treatment data were analyzed. Proportions were compared using Pearson Chi squared tests. Results: From 2000-2008, 27,365 cases of stage III melanoma were reported to NCDB. Most patients were male (63%) and Caucasian (94.2%). Twenty-nine percent were over the age of 70. Educational and socioeconomic factors across all age groups were not significantly different. The primary insurer for patients younger than 60 was a managed care plan (54.3%) as compared to Medicare with supplemental insurance for patients older than 60 (47.4%). In terms of systemic therapy, 23% received immunotherapy alone, 6% received chemotherapy alone, 2% received both, and 66% received no therapy. When compared to patients under age 39, older age groups were significantly less likely to receive adjuvant immunotherapy as shown in the table below. Conclusions: There is an inverse relationship between age and the use of adjuvant immunotherapy. Further study is planned to adjust for comorbidity, socioeconomic status using patient-level data. [Table: see text]

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