Clozapine and COVID-19: A Case Report and Clinical Considerations

2021 ◽  
Vol 16 ◽  
Author(s):  
Dylan Lahiff ◽  
Peggy Chatham ◽  
Gregory Sullivan ◽  
Adam J. Fusick
Keyword(s):  
Clinical Decision Making ◽  
Synergistic Effects ◽  
Clinical Decision ◽  
Clinical Experiences ◽  
Medical Specialties ◽  
Case Presentation ◽  
Global Epidemic ◽  
Coronavirus Infection ◽  
Limited Compliance ◽  
Potential Interactions

Background: The emergence of coronavirus SARS-CoV-2, and the subsequent global epidemic of COVID-19, brought with it innumerable new clinical experiences across all medical specialties, and psychiatry is no exception. Individuals with serious mental illness, in particular schizophrenia and related disorders, may be especially susceptible to coronavirus infection given the overlapping risk factors of vulnerable sociodemographic status, increased challenges with quarantining requirements, and limited compliance with “respiratory etiquette.” The case presented here describes a patient with schizophrenia who was being managed on clozapine and who developed symptomatic COVID-19 infection. Special care was taken to ensure that potential interactions between clozapine and the associated COVID-19 treatments were safe for the patient’s mental and physical wellbeing. Case Presentation: A 71-year-old schizophrenic Caucasian male is being managed with clozapine. While hospitalized, the patient was screened positive for COVID-19 and was admitted to the ICU due to his declining respiratory status. He was treated with both remdesivir and prednisone. He was able to fully recover from his COVID-19 infection. Conclusion: The authors review the clinical characteristics of the case, highlighting both the overlapping synergistic effects and antagonistic influences of clozapine therapy in combination with COVID-19 and its associated treatments. A review of the literature offers an opportunity to examine various frameworks for individualized clinical decision-making while making the case for greater epidemiologic research into the optimal management of individuals with a psychotic disorder who are diagnosed with COVID-19 infection.

scholarly journals Vici syndrome in an Egyptian infant: case report and differential diagnosis of inherited hypopigmented disorders

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwa Abd Elmaksoud ◽  
Aya Attya Abeesh ◽  
Catarina Pereira ◽  
Marwa El-Saeed El-Deeb
Keyword(s):  
Differential Diagnosis ◽  
Corpus Callosum ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Phenotype Correlation ◽  
Multisystem Disease ◽  
Case Presentation ◽  
Correlation Studies ◽  
Clinical Description ◽  
Infant Case

Abstract Background Vici syndrome is a severe inherited multisystem disease caused by mutations in the EPG5 gene. The diagnosis depends on the constellation of cardinal features of agenesis of the corpus callosum, cataracts, oculocutaneous hypopigmentation, cardiomyopathy, and a combined immunodeficiency followed by confirmation by genetic testing. We report an Egyptian infant with Vici syndrome carrying a homozygous splice site variant (c.1252+1G>T; NM_020964.2) in the EPG5 gene, detailed clinical description, outcome, and differential diagnosis of inherited hypopigmentation disorders associated with neurological manifestations. Case presentation The infant initially presented with oculocutaneous hypopigmentation, agenesis of the corpus callosum, and immunodeficiency. A few months later, a diagnosis of dilated cardiomyopathy was made. Family history revealed 2 deceased siblings phenotypically matching our index infant. He died at the age of 15 months with acute respiratory failure. Conclusion The accurate diagnosis of such rare diseases with genetic confirmation is vital for proper clinical decision-making, genetic counseling of the affected families, and future genotype-phenotype correlation studies.

Benner’s Framework and Clinical Decision-Making in the Critical Care Environment

2016 ◽  
Vol 30 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Kristi J. Stinson
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Experience ◽  
Strong Correlation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Clinical Experiences ◽  
Care Environment ◽  
Decision Making Processes

Completed as part of a larger dissertational study, the purpose of this portion of this descriptive correlational study was to examine the relationships among registered nurses’ clinical experiences and clinical decision-making processes in the critical care environment. The results indicated that there is no strong correlation between clinical experience in general and clinical experience in critical care and clinical decision-making. There were no differences found in any of the Benner stages of clinical experience in relation to the overall clinical decision-making process.

Liposarcoma of the left hemithorax and implications of MDM2

2019 ◽  
Vol 18 (4) ◽  
pp. 397-399
Author(s):  
Michael Stolten ◽  
Deepak Sahasrabudhe ◽  
Louis Constine
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Adjuvant Radiation ◽  
Left Hemithorax ◽  
Case Presentation ◽  
Close Observation ◽  
Initial Biopsy ◽  
Molecular Information ◽  
Well Differentiated

AbstractBackground:Use of molecular information to guide clinical management of thoracic liposarcoma following resection.Case presentation:We present a case of a large liposarcoma of the left hemithorax. Initial biopsy consistent with lipoma however following resection pathology showed well-differentiated liposarcoma. Clinical data and molecular information including MDM2 from the tumour were employed in decision making regarding subsequent adjuvant radiation therapy versus close observation.Conclusion:Improved molecular characterisation has increased the precision of histological diagnoses and prediction of outcomes for many cancers. These may continue to help guide and strengthen clinical decision making and recommendations as they pertain to adjuvant therapy versus observation in the case of this patient.

scholarly journals Artificial intelligence in arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Glen Purnomo ◽  
Seng-Jin Yeo ◽  
Ming Han Lincoln Liow
Keyword(s):  
Artificial Intelligence ◽  
Clinical Decision Making ◽  
Recent Literature ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Patient Specific ◽  
Allocation Decision ◽  
Medical Specialties ◽  
Future Direction ◽  
Improve Patient

AbstractArtificial intelligence (AI) is altering the world of medicine. Given the rapid advances in technology, computers are now able to learn and improve, imitating humanoid cognitive function. AI applications currently exist in various medical specialties, some of which are already in clinical use. This review presents the potential uses and limitations of AI in arthroplasty to provide a better understanding of the existing technology and future direction of this field.Recent literature demonstrates that the utilization of AI in the field of arthroplasty has the potential to improve patient care through better diagnosis, screening, planning, monitoring, and prediction. The implementation of AI technology will enable arthroplasty surgeons to provide patient-specific management in clinical decision making, preoperative health optimization, resource allocation, decision support, and early intervention. While this technology presents a variety of exciting opportunities, it also has several limitations and challenges that need to be overcome to ensure its safety and effectiveness.

Gastric cancer in a teenager: a case report

2017 ◽  
Vol 31 (6) ◽  
Author(s):  
Itai Ghersin ◽  
Lior H. Katz
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Diagnostic Delay ◽  
Young Patients ◽  
Clinical Decision ◽  
Critical Importance ◽  
Case Presentation ◽  
Female Soldier

Abstract Background Gastric cancer occurs mainly in older patients, with a peak incidence over 60 years of age. It is relatively rare among younger individuals. However, the frequency of gastric cancer in young patients appears to be on the rise worldwide. Case presentation We report the case of a 19-year-old female soldier who, after a considerable diagnostic delay, was diagnosed with gastric adenocarcinoma. She is one of the youngest gastric adenocarcinoma patients ever reported in Israel. Conclusion This case should serve as a reminder that gastric carcinoma is a possible diagnosis even in young patients. It also highlights the critical importance of obtaining a thorough medical history in the process of clinical decision making.

Clinical Decision Making in Speech-Language Intervention for Toddlers With Autism and Other Social Communication Delays

2019 ◽  
Vol 4 (2) ◽  
pp. 228-239 ◽  
Author(s):  
Sheri T. Stronach ◽  
Janine L. Schmedding-Bartley
Keyword(s):  
Decision Making ◽  
Young Children ◽  
Continuing Education ◽  
Social Communication ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Language Intervention ◽  
Communication Delays ◽  
Clinical Experiences ◽  
Speech Language Pathologists

Purpose This study investigated current speech-language intervention practices with young children with social communication delays including autism and the educational experiences that shape these practices. Method A 25-item web-based survey was completed by 264 speech-language pathologists who worked with children under the age of 3 years. Results A majority of respondents reported targeting a variety of areas of social communication across daily activities, regularly utilizing the parent as the primary agent, and often providing in-home services; however, a minority of respondents reported only using materials available in families' homes. Previous clinical experiences and continuing education were reported to most influence clinical decision making. Results indicated the incorporation of many aspects of evidence-based naturalistic interventions into practice and the use of continuing education opportunities to expand clinical knowledge. Conclusion Although speech-language pathologists reported promising directions toward recommended best practices, further research and training are needed to optimize services provided to young children and their families.

Clinical Experiences with Dental Implants

1999 ◽  
Vol 13 (1) ◽  
pp. 147-152 ◽  
Author(s):  
Patrick J. Henry
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Success Rates ◽  
Clinical Experiences ◽  
Advantages And Disadvantages ◽  
Clinical Utilization ◽  
Large Numbers ◽  
New Applications ◽  
Term Data

The clinical utilization of dental impants has accelerated in recent years, and new applications continue to emerge. Concomitantly, alternative implant systems have introduced conceptually different approaches to treatment using altered protocols. The purpose of this paper is to address some of the background issues pertinent to the long-term success, survival, safety, and effectiveness of these devices. The requirements for clinical acceptance of implants are controlled initially by regulatory bodies; however, the dentist eventually must make a decision on which type of implant should be used in clinical practice. This clinical decision-making process should involve the strategy of using an evidence-based approach to ensure quality of care and reduction of liability for negligent care. This is particularly the case when treatment is undertaken in identified high-risk categories. While short- to medium-term data have been accumulated on the success rates of several implant systems, it is apparent that long-term data comparing and contrasting the various advantages and disadvantages of different systems do not exist, and adequate criteria applicable to the collective clinical experience need to be defined. Expanding areas of application are dependent on continuous improvements in implant hardware, surgical protocol development, and rationalized osteopromotive and site installation augmentation technology. Many treatment endeavors are still largely at the pilot study level of development, and long-term prospective clinical trials on large numbers of patients are required to document results adequately and to elucidate the most likely productive areas for future investigation.

scholarly journals The Influence of Electronic Health Record Use on Collaboration Among Medical Specialties

2020 ◽  
Author(s):  
Janita F.J. Vos ◽  
Albert Boonstra ◽  
Arjen Kooistra ◽  
Marc Seelen ◽  
Marjolein van Offenbeek
Keyword(s):  
User Interfaces ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Collective Responsibility ◽  
Clinical Decision ◽  
Relevant Information ◽  
Outpatient Clinics ◽  
Structured Interviews ◽  
Medical Specialties ◽  
Mutual Awareness

Abstract Background:One of the main objectives ofElectronic Health Records (EHRs) is to enhancecollaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaborationin five outpatient clinics.Methods: We conducted an embedded case study at five multidisciplinary outpatient clinics of a hospital that had implemented organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.Results:Our findings demonstratehow an EHRwill simultaneously bothfacilitate andconstrain collaborationamong specialties and disciplines. Affordances that were inscribed in the system for collaboration purposeswere not fully actualized in the focal hospital because:(a)The EHR helps health professionalscoordinate patient care on an informed basis at any time and in any placebut only allows asynchronouspatient record use.(b)The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital.(c)The reduced necessity forface-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow.(d)The EHR affords registration at the source and full registration of activities through orders, but the heightened administrative burdenfor physicians and the strict authorization rules on inputting dataconstrainthe flexible, multidisciplinary collaboration.(e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.Conclusions: For the optimal actualization of EHRs’collaborative affordancesin hospitals, coordinated use of these affordancesby health professionalsis a prerequisite.Suchcoordinated userequires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies toenhance trust in both the EHR and in its coordinated usefor effective collaboration are offered.

scholarly journals False hyperthyroidism caused by interference in immunoassays

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Clara Jiménez García ◽  
Piedad Ortega Fernández ◽  
María Eugenia Torregrosa Quesada ◽  
Victoria González Bueno ◽  
María Teresa Botella Belda ◽  
...  
Keyword(s):  
Decision Making ◽  
Thyroid Hormone ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Case Presentation ◽  
Free Thyroid Hormone ◽  
Different Types

AbstractObjectivesImmunoassays used to assess thyroid function are vulnerable to different types of interference that may affect clinical decision-making.Case presentationWe report the case of a 37-year-old woman who developed iatrogenic hypothyroidism after having received radioiode therapy who visited our hospital for her annual checkup. The patient was asymptomatic, without signs suggestive of thyroid disease. However, laboratory analysis proved otherwise: thyrotropin (TSH) 7.75 mU/L, thyroxine (FT4) >7.7 ng/dL.ConclusionsThe inconsistency between her clinical symptoms and the biochemistry data raised the possibility of a methodological interference. A thorough evaluation of the main causes of interference was conducted in the laboratory to exclude the presence of interference in TSH and FT4. Finally, different interfering agents were identified, which affected free thyroid hormone and TSH determination.

Differences in Attitudes toward Patients among Medical Specialties

1989 ◽  
Vol 18 (3) ◽  
pp. 223-233 ◽  
Author(s):  
Gerald Roskin ◽  
Susan K. Marell
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Approach ◽  
Clinical Decision ◽  
Medical Specialties ◽  
Attitudinal Dimension ◽  
The Impact ◽  
Moral Weakness ◽  
And Training

In a prior study a questionnaire was developed which reliably measured a variety of physicians' attitudes toward patients [1]. In the present study we have used this questionnaire to compare the attitudes of physicians specializing in Internal Medicine, Surgery, Pediatrics and Psychiatry with one another and with a group of medical students. One way analyses of variance yielded highly significant differences ( p < .001) among these groups on the “Nurturant-Empathic” attitudinal dimension, as well as on the “Psychodynamic” and “Moral Weakness” Etiology Scales. Significance and ramifications of these findings are discussed in terms of the impact of these attitudes on treatment approach, clinical decision-making, and quality and comprehensiveness of patient care. Further, these findings suggest that a variety of education and training approaches could be advantageously utilized to integrate and upgrade the care of patients by the different medical specialties.

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