scholarly journals Trends in clinical practice and its effect on relapse among patients with severe mental disorders in Ethiopia: a retrospective chart review

2021 ◽  
Author(s):  
Tolesa Fanta ◽  
Kibrom Haile Hagos ◽  
Edao Fejo Hamda ◽  
Eliyas Haile ◽  
Alem Kebede Ejigu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Drug Discontinuation ◽  
History Taking ◽  
Severe Mental Disorders ◽  
Basic Care ◽  
First Contact

Abstract Background Studies have suggested that developing good trends in clinical practices in adherence to the recommended processes and guidelines for basic care have been associated with good health outcomes. However, no previous studies have explored trends in psychiatric practices and their impact on relapse among patients with severe mental disorders. Methods: We conducted a retrospective chart review of 401 patients with severe psychiatric disorders selected by systematic random sampling technique. Trends in clinical practice were assessed by a tool adapted from published evidence based on advice from well-known experts in psychiatric practice. A univariable and multivariable logistic regression model was used to investigate the association between psychiatric practices and relapse. Results This study provided evidence of a significant deficit in adherence to the recommended practices of basic care. The vast majority of professionals were not following the appropriate psychiatry history-taking format at first contact (73.6%), not documented the reasons for drug discontinuation (88.5%), did not follow the correct guideline of shifting across psychrotrophic medications (86.8%), and did not put their name or signature on the chart (61.8%). In multivariable analysis, not following psychiatric history taking format at first contact 1.63 (1.04, 2.56)], the diagnosis of bipolar disorders [4.85 (2.01, 8.36)], drug discontinuation after a short duration of treatment [1.21 (1.02, 2.42)], poor documentation of patient data during follow up [3.10 (2.35, 4.43)], absence of name and signature of treating physician on the chart [7.58 (2.64, 21.79)], and failing to treat medication side effect [2.55 (1.02, 6.39)] were found to significant predictors of relapse among the participants. Conclusions The findings provided evidence of notably higher rates of deficits in adherence to the existing guideline of basic psychiatric care, which resulted in a higher risk of relapse among patients with severe psychiatric disorders.

Destination of Mental Disorders Through Biochemical and Neuropathological Analysis?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Falkai
Keyword(s):  
Positron Emission Tomography ◽  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Clinical Symptoms ◽  
Emission Tomography ◽  
Imaging Findings ◽  
Severe Mental Disorders ◽  
Positron Emission ◽  
Dopamine Hypothesis

In the first half of the last century researchers believed that severe mental disorders like schizophrenia have a neuropathological basis. Up to now it has been difficult to prove any consistent core finding for this disorder. Reason for this might be that it is a network disorder and therefore regional specific findings will unlikely be found. Parallel to that describing the dopamine hypothesis of schizophrenia and the catechol amine deficit hypothesis of depression were very helpful for understanding the mechanisms of antipsychotics and antidepressants working in these disorders. Especially the introduction of the positron emission tomography has helped to link symptoms with the transmitter systems. However, none of these findings are specific for schizophrenia or depression. During the talk it will be discussed when the combination of core clinical symptoms, imaging findings and genetic variables are helpful for a future classification of psychiatric disorders.

scholarly journals Real-world ibrutinib dose reductions, holds and discontinuations in chronic lymphocytic leukemia

2021 ◽  
Author(s):  
Jing-Zhou Hou ◽  
Kellie Ryan ◽  
Senxi Du ◽  
Bruno Fang ◽  
Stanley Marks ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Chronic Lymphocytic Leukemia ◽  
Adverse Events ◽  
Dose Reduction ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Routine Clinical Practice ◽  
Lymphocytic Leukemia ◽  
First Line ◽  
Dose Reductions

Aim: A retrospective chart review of ibrutinib-treated patients with chronic lymphocytic leukemia (CLL) was conducted. Patients & methods: Adults with CLL who initiated ibrutinib were followed for ≥6 months (n = 180). Results: Twenty-five percent of first-line ibrutinib patients experienced ≥1 dose reduction, mainly due to adverse events (AEs; 79%). Treatment discontinuations and dose holds occurred in 20 and 34% of patients, respectively, most commonly due to AEs (73 and 74%). Approximately one-quarter of relapsed/refractory ibrutinib patients experienced ≥1 dose reduction, mainly due to AEs (88%). Treatment discontinuation and dose holds occurred in 40% of patients (58 and 76% due to AEs, respectively). Conclusion: Dose reductions, holds and discontinuations were frequent in patients with CLL receiving ibrutinib in routine clinical practice.

Mental Disorders Frequently Diagnosed in Patients with Chronic Pain in an Outpatient Pain Management Clinic: A Retrospective Chart Review

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S290-S291
Author(s):  
Phuong Q. Tien ◽  
Ake Evans ◽  
Matt Root ◽  
Francis P. Lagattuta ◽  
Winston F. Montero ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Mental Disorders ◽  
Chart Review ◽  
Retrospective Chart Review

A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting

2018 ◽  
Vol 36 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Giovanna Sirianni ◽  
Giulia Perri ◽  
Jeannie Callum ◽  
Sandra Gardner ◽  
Anna Berall ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Palliative Care Unit ◽  
Assessment Tools ◽  
Palliative Care Units

Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting. Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada. The goals were to elucidate the frequency, indications, patient characteristics, and practices around this intervention. Design: Descriptive, retrospective chart review. Setting/Participants: The clinical charts of patients admitted to the palliative care unit and who obtained blood transfusions for the period of April 1, 2015, to March 31, 2017, were reviewed. All patients admitted who obtained a transfusion were included. There were no exclusion criteria. Results: Transfusions in the palliative care units were rare despite their availability (0.9% at Sunnybrook and 1.4% Baycrest) and were primarily given to patients with cancer. The main symptom issues identified for transfusion were fatigue and dyspnea. The majority of patients endorsed symptomatic benefit with minimal adverse reactions though pre- and post-transfusion assessment practices varied greatly between institutions. Conclusions: Transfusions in the palliative care units were infrequent, symptom targeted, and well tolerated, though the lack of standardized pre/post assessment tools limits any ability to draw conclusions about utility. Patients would benefit from additional research in this area and the development of clinical practice guidelines for transfusions in palliative care.

scholarly journals Dose Escalation and Co-therapy Intensification Between Etanercept, Adalimumab, and Infliximab: The CADURA Study

2017 ◽  
Vol 11 (1) ◽  
pp. 123-135 ◽  
Author(s):  
Carter Thorne ◽  
Gilles Boire ◽  
Andrew Chow ◽  
Kirsten Garces ◽  
Fang Liu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Dose Escalation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Routine Clinical Practice ◽  
Total Drug

Objective: To compare anti-TNF dose escalation, DMARD and/or glucocorticoid intensification, switches to another biologic, and drug and drug-related costs over 12 and 18 months for rheumatoid arthritis (RA) patients initiating etanercept (ETN), adalimumab (ADA), or infliximab (IFX) in routine clinical practice across Canada. Methods: A retrospective chart review of biologic-naïve adult RA patients newly initiating ADA, ETN, or IFX between January 01, 2006 and December 31, 2012 from 11 practices across Canada. Results: There were 314 patients in the 12-month analysis and 217 in the 18-month analysis. No dose escalation occurred with ETN over 12 and 18 months versus 38% and 32% for IFX (p<0.001) and 2% and 2% for ADA (p=0.199, p=0.218). Over 18 months, dose escalation and/or DMARD and/or glucocorticoid intensification was less frequent among ETN (16%) versus IFX (44%, p=0.005) and ADA (34%, p=0.004). By 18 months, 22% of patients initiating ADA had switched to another biologic compared with 6% of ETN patients (p=0.001). Patients initiating ETN had lower total (drug and drug-related) costs over 12 and 18 months compared to IFX, and no difference compared to ADA when adjusted for potential confounders. Patients with dose escalation had higher costs compared to those with no dose escalation. Conclusion: Physicians were more likely to escalate the dose of IFX, but optimize co-therapy with ADA and ETN. ETN patients had no dose escalation and were less likely to have DMARD and/or glucocorticoid intensification than ADA patients. ETN-treated patients had lower costs compared to IFX patients.

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