scholarly journals Antidepressant use in adults with intellectual disability

2010 ◽  
Vol 34 (4) ◽  
pp. 123-126 ◽  
Author(s):  
Prem R. Rai ◽  
Mike Kerr
Keyword(s):  
Intellectual Disability ◽  
Side Effects ◽  
Clinical Outcome ◽  
Learning Disability ◽  
Clinical Improvement ◽  
Positive Outcome ◽  
Clinical Implications ◽  
Service Users ◽  
Antidepressant Use

Aims and methodTo study the use of antidepressants in adults with intellectual disability, focusing on medication type, indication, retention and clinical outcome. Case notes of all service users in a learning disability service were hand-searched to identify antidepressant usage, and those who had been treated with antidepressants and in whom at least 1 year of follow-up was possible were included in the study.ResultsA total of 241 treatment episodes were identified. The rates of positive outcome in terms of clinical improvement at 6 weeks, 6 months and 12 months were 49.4%, 48.1% and 49% respectively, and only 29 (12%) episodes of side-effects had been noted.Clinical implicationsAntidepressants are commonly prescribed in adults with intellectual disability. Approximately half did well in terms of clinical improvement.

Incidence and clinical implications of stent fractures of the Xpert self-expanding nitinol stent in infrainguinal arteries

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Keo ◽  
Kickuth ◽  
Diehm ◽  
Baumgartner ◽  
Dai-Do
Keyword(s):  
Clinical Outcome ◽  
Clinical Improvement ◽  
Clinical Implications ◽  
Stent Fracture ◽  
Fracture Rate ◽  
Stent Patency ◽  
Nitinol Stent ◽  
Infrainguinal Arteries ◽  
Unfavorable Clinical Outcome

Background: Different stents in infrainguinal arteries have recently been associated with stent fractures and unfavorable clinical outcome, although data is limited regarding fractures of the Xpert selfexpanding nitinol stent. Thus, purpose of the present investigation was to evaluate its incidence and clinical implications in lower limb arteries. Patients and methods: Fifty-three consecutive patients (53 limbs) with peripheral arterial disease underwent secondary Xpert stent implantation due to suboptimal primary balloon angioplasty (PTA). Median age was 76 years. Stent fractures were evaluated by plain X-ray at median follow-up of 16 months. Stent patency was assessed by duplex ultrasound and sustained clinical improvement was defined as improvement of the ABI of ≥ 0.10 together with improvement of at least one Rutherford class above the baseline finding throughout follow-up. Results: Median length of femoropopliteal and infrapopliteal lesion was 3.0 and 2.3 cm, respectively. Sixtyfive stents were implanted in 43 limbs with femoropopliteal and 10 stents in 10 limbs with infrapopliteal lesion, respectively. Stent fractures occurred in 3 of 43 limbs (7.0%) of patients with femoropopliteal lesion with stent-based fracture rate of 4.6%. All fractured stents showed multiple struts fractures and occurred in the distal and middle superficial femoral artery. No stent fracture was observed in infrapopliteal lesions. The fractured stents were not associated with any clinical deterioration. Sustained clinical improvement was 71.0% and 54.6% for femoropopliteal and infrapopliteal lesions, respectively. Stent patency assessed by duplex was 65.2 and 63.9% for femoropopliteal and infrapopliteal lesions, respectively. Conclusions: Fractures of the Xpert stent were seldom and not associated with unfavorable clinical outcome at midterm follow-up.

scholarly journals Delay in the discharge of psychiatric in-patients with learning disabilities

2000 ◽  
Vol 24 (5) ◽  
pp. 179-181 ◽  
Author(s):  
R.V. Watts ◽  
P. Richold ◽  
T. P. Berney
Keyword(s):  
Learning Disabilities ◽  
Learning Disability ◽  
Psychiatric Inpatients ◽  
Clinical Implications ◽  
Service Users ◽  
Disability Service

Aims and MethodThe study aimed to identify factors delaying discharge of psychiatric inpatients from a learning disability service. A census was completed, categorising in-patients as unready for discharge (n=181); discharge planned within 12 weeks (n=22); or ready for discharge but experiencing delay (n=44), the latter were followed-up 16 months later.ResultsDelayed patients were more disabled or disturbed and often awaiting adequate community provision. They were older, had been in hospital longer and were ‘informal’ admissions. At follow-up 23 remained in hospital, 21 of whom had been delayed by lack of placement.Clinical ImplicationsDe-institutionalisation has led to the expectation that more complex and challenging people be placed in the community. This study suggests the community to be, as yet, unready to cope with the needs of these service users.

Outcome of thoracolumbar surgical feline intervertebral disc disease

2021 ◽  
pp. 1098612X2110280
Author(s):  
Kayla M Fowler ◽  
Theresa E Pancotto ◽  
Stephen R Werre ◽  
Michaela J Beasley ◽  
William Kay ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intervertebral Disc ◽  
Positive Outcome ◽  
Intervertebral Disc Herniation ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Exact Test ◽  
Imaging Results ◽  
Larger Sample

Objectives The aim of this study was to evaluate the outcome and prognosis of thoracolumbar feline intervertebral disc disease (IVDD) treated by surgical decompression. Methods This was a multi-institutional retrospective study evaluating the age, breed, sex, body weight, presenting complaint, neuroanatomic diagnosis at presentation, diagnostic imaging results, surgery performed and the overall outcome at discharge and at recheck. Bivariable associations between variables were assessed using the Kruskal–Wallis test (age and grade of IVDD at presentation) and Fisher’s exact test (grade of IVDD at presentation and outcome). Results A total of 35 cats met the inclusion criteria for the study. The most frequently reported clinical sign was difficulty walking (54.2%). The majority of cats presented with an L4–S3 localization (57%). The most common site of intervertebral disc herniation (IVDH) was at L6–L7 (34%). The majority of feline patients that received surgery had a positive outcome at the time of discharge (62.5%; n = 20/32) and at the time of the 2-week recheck (91.3%; n = 21/23). No association was identified between the age of the patient and the grade of IVDD. No association was identified between the presenting grade of IVDD and the clinical outcome at the time of discharge or at the time of recheck evaluation. Conclusions and relevance Cats undergoing spinal decompressive surgery for thoracolumbar IVDH appear to have a favorable prognosis independent of the initial presenting grade of IVDD. A larger sample size and a longer length of follow-up is necessary to obtain statistical associations between the presenting grade of IVDD and overall clinical outcome.

scholarly journals Outcome measures and treatment effectiveness in late onset myasthenia gravis

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Francesca Pasqualin ◽  
Silvia V. Guidoni ◽  
Mario Ermani ◽  
Elena Pegoraro ◽  
Domenico M. Bonifati
Keyword(s):  
Side Effects ◽  
Myasthenia Gravis ◽  
Outcome Measures ◽  
Clinical Features ◽  
Early Onset ◽  
Treatment Effectiveness ◽  
Late Onset ◽  
Positive Outcome ◽  
Response To Treatment

Abstract Background Recently different subtypes of myasthenia gravis (MG) have been described. They differ for clinical features and pathogenesis but the prognosis and response to treatment is less clear. The aim of the study was to evaluate outcome and treatment effectiveness including side effects in late onset MG (LOMG) compared with early onset MG (EOMG). Methods We analysed retrospectively 208 MG patients. Clinical features were recorded as well as treatment and side effects. Outcome at the last follow-up was evaluated with MGSTI and MGPIS scales. Results The 208 patients included were classified as follow: 36 ocular MG, 40 EOMG, 72 LOMG, 25 thymoma-associated, 14 anti-MuSK and 21 double seronegative. Similar positive outcome was achieved in either early and late onset subgroup. We found pharmacological remission and minimal manifestations at the MGFA-PIS in the 95% and 94,4% of EOMG and LOMG respectively but in LOMG a lower dose of immunosuppressors (MGSTI< 2) was required compared to EOMG (p = 0,048). Severe side effects were present in a small percentage of patients in both group but diabetes was more frequent in LOMG vs EOMG (2,2% vs 5%, p = 0.017). Conclusions Despite LOMG has more comorbidities that might interfere with treatment and outcome, therapeutic management does not seem to differ between EOMG and LOMG. A similar positive outcome was seen in both subgroups but LOMG group seems to require lower doses of medication to control symptoms.

scholarly journals Hyperbaric Oxygen for Radiation Necrosis of the Brain

2019 ◽  
Vol 47 (1) ◽  
pp. 92-99
Author(s):  
Jayson Co ◽  
Marcus Vinicius De Moraes ◽  
Rita Katznelson ◽  
A. Wayne Evans ◽  
David Shultz ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Median Time ◽  
Hyperbaric Oxygen ◽  
Demographic Data ◽  
Symptom Improvement ◽  
Presenting Symptoms ◽  
Transient Improvement ◽  
Brain Radiation

Abstract:Introduction:Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution.Methods:This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction.Results:Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1–109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin.Conclusions:HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.

scholarly journals Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience

2019 ◽  
Vol 7 (2) ◽  
pp. 200-203
Author(s):  
Anh Tran Thi Van ◽  
Anh Tran Lan ◽  
Minh Ha Anh ◽  
Thuong Nguyen Van ◽  
Phuong Pham Thi Minh ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Alopecia Areata ◽  
Hair Growth ◽  
Efficacy And Safety ◽  
National Hospital ◽  
Withdrawal Treatment ◽  
Pulse Dose ◽  
Pre Treatment

BACKGROUND: Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE: To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS: The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS: After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION: Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

scholarly journals The Mental Health Clustering Tool for people with severe intellectual disability

2012 ◽  
Vol 36 (12) ◽  
pp. 454-458 ◽  
Author(s):  
Vishwa Radhakrishnan ◽  
Kevin Smith ◽  
Jean O'Hara
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Community Mental Health ◽  
Learning Disability ◽  
Rating Scales ◽  
Disability Services ◽  
Clinical Implications ◽  
Current Form ◽  
Severe Intellectual Disability ◽  
Integrated Mental Health

Aims and methodWe assessed 92% (117/127) of the patients in our community mental health learning disability team using the Mental Health Clustering Tool (MHCT) to establish whether their needs could be captured sufficiently well to enable assignment to a care cluster for payment by results in mental health. We explored the characteristics of those assigned to Cluster 0 to identify how they differed from those who could be assigned to Clusters 1-21.ResultsAs expected, nearly half of the case-load (48%) could not be assigned to any cluster except Cluster 0, the variance cluster, which is used when the needs of patients cannot be captured by the current 21 care clusters but a service is, or will be, provided.Clinical implicationsThe MHCT in its current form does not adequately capture the needs of people with more severe intellectual disability. An integrated mental health and learning disability clustering tool is in development. This is expected to include new rating scales and new clusters, however until the development is completed and validated it will not be possible to implement payment by results in mental health in learning disability services.

scholarly journals Losing participants before the trial ends erodes credibility of findings

2009 ◽  
Vol 33 (7) ◽  
pp. 254-257 ◽  
Author(s):  
Jun Xia ◽  
Clive Adams ◽  
Nishant Bhagat ◽  
Vinaya Bhagat ◽  
Paranthaman Bhoopathi ◽  
...  
Keyword(s):  
Service User ◽  
Trial Design ◽  
Pragmatic Trial ◽  
Drug Trial ◽  
Clinical Implications ◽  
Service Users ◽  
Drug Trials

Aims and MethodTo estimate the proportion of attrition at which results of drug trials for people with schizophrenia lose enough credibility to become mistrusted by relevant groups of stakeholders. A piloted questionnaire was sent to 128 local clinicians, 100 relevant researchers and 104 service users and carers.ResultsWe received the biggest number of responses from the service user and carer group (n=81, 76%); 43% of clinicians and 32% of researchers responded. All three groups suggested that the follow-up rate for a 12-week schizophrenia drug trial should be around 70–75% for the trial to be credible.Clinical ImplicationsThis survey suggests that relevant stakeholders, including researchers, fundamentally mistrust results of the majority of drug trials in schizophrenia. Adopting a more pragmatic trial design can help address this.

scholarly journals Telepsychiatry in intellectual disability psychiatry: literature review

2019 ◽  
Vol 43 (4) ◽  
pp. 167-173
Author(s):  
Giri Madhavan
Keyword(s):  
Intellectual Disability ◽  
Literature Review ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Healthcare Systems ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
Face To Face ◽  
Research And Innovation

Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted.ResultsFour USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.

scholarly journals Genetic testing of adults with intellectual disability

2012 ◽  
Vol 36 (11) ◽  
pp. 409-413 ◽  
Author(s):  
Jana de Villiers ◽  
Mary Porteous
Keyword(s):  
Intellectual Disability ◽  
Genetic Testing ◽  
Learning Disability ◽  
Genetic Diagnosis ◽  
Disability Services ◽  
Clinical Implications ◽  
Clinical Genetics ◽  
Genetic Abnormality ◽  
Structured Interviews ◽  
Health Boards

MethodPatients known to learning disability services in two health boards in southeast Scotland were cross-matched with the patients tested at the Western General Hospital in Edinburgh. Those with a positive genetic diagnosis were identified. Semi-structured interviews were conducted with senior learning disability psychiatrists and clinical genetics consultants.ResultsOf the 3323 patients with intellectual disability across both health boards, 41% have had genetic tests and 6% have an identified genetic abnormality as the cause for their intellectual disability. Of the 1349 patients who have been tested, a genetic abnormality was found in 14%. Psychiatrists named several benefits to genetic testing, but they also highlighted a number of non-medical reasons for not testing adults with intellectual disability.Clinical implicationsIdentifying genetic aetiology in intellectual disability has a number of benefits. Our study would indicate that genetic diagnoses are being missed due to a lack of genetic testing in this patient group. Adult learning disability services need to consider increasing genetic testing.

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