scholarly journals Impact of a pharmacist-driven tardive dyskinesia screening service

2021 ◽  
Vol 11 (4) ◽  
pp. 248-253
Author(s):  
Niyati Butala ◽  
Andrew Williams ◽  
Jamie Kneebusch ◽  
Melissa Mitchell
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Tardive Dyskinesia ◽  
Early Recognition ◽  
Involuntary Movement ◽  
Standard Of Care ◽  
Primary Objective ◽  
Psychiatric Facility ◽  
Screening Service ◽  
Regular Monitoring

Abstract Introduction Tardive dyskinesia (TD) is defined as involuntary movements that can develop with prolonged antipsychotic use. Regular monitoring using the Abnormal Involuntary Movement Scale (AIMS) is recommended to be conducted every 3 to 6 months for early recognition, although the AIMS is underused. Several studies have investigated risk factors that may be associated with TD, including age, sex, and long-term antipsychotic use. This study aimed to increase the monitoring and treatment of TD for those assessed to be at higher risk. Methods This was a prospective quality improvement study on the effectiveness of a psychiatric pharmacist–driven TD screening service (PPDTSS) in an inpatient psychiatric facility. Participants were composed of adult patients admitted between May and November 2018. Patients were screened daily by a clinical pharmacist and, if determined to be high risk based on studied risk factors, prioritized to receive a formal TD screening via the AIMS. The primary objective was to optimize standard of care by increasing the number of AIMS screenings conducted. The secondary objective was to increase the treatment of TD. Results A total of 402 patients were assessed prior to implementation of the PPDTSS, and 390 patients were screened following implementation. The PPDTSS increased the number of AIMS screenings attempted by 85.1% for high-risk individuals. Of the 75 patients who had an AIMS screening attempted in the postintervention group, 46 (61.3%) had an AIMS screening completed, of which 3 (6.5%) were positive. Discussion The results of this study demonstrate that psychiatric pharmacists can be used to improve the regular monitoring of patients at high risk for TD.

scholarly journals Clustering Heatmap for Visualizing and Exploring Complex and High-dimensional Data Related to Chronic Kidney Disease

2020 ◽  
Vol 9 (2) ◽  
pp. 403 ◽  
Author(s):  
Cheng-Sheng Yu ◽  
Chang-Hsien Lin ◽  
Yu-Jiun Lin ◽  
Shiyng-Yu Lin ◽  
Sen-Te Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Complex Disease ◽  
Early Recognition ◽  
Adverse Outcomes ◽  
Rapid Decline ◽  
Rapid Progression

Background: Preventive medicine and primary health care are essential for patients with chronic kidney disease (CKD) because the symptoms of CKD may not appear until the renal function is severely compromised. Early identification of the risk factors of CKD is critical for preventing kidney damage and adverse outcomes. Early recognition of rapid progression to advanced CKD in certain high-risk populations is vital. Methods: This is a retrospective cohort study, the population screened and the site where the study has been performed. Multivariate statistical analysis was used to assess the prediction of CKD as many potential risk factors are involved. The clustering heatmap and random forest provides an interactive visualization for the classification of patients with different CKD stages. Results: uric acid, blood urea nitrogen, waist circumference, serum glutamic oxaloacetic transaminase, and hemoglobin A1c (HbA1c) were significantly associated with CKD. CKD was highly associated with obesity, hyperglycemia, and liver function. Hypertension and HbA1c were in the same cluster with a similar pattern, whereas high-density lipoprotein cholesterol had an opposite pattern, which was also verified using heatmap. Early staged CKD patients who are grouped into the same cluster as advanced staged CKD patients could be at high risk for rapid decline of kidney function and should be closely monitored. Conclusions: The clustering heatmap provided a new predictive model of health care management for patients at high risk of rapid CKD progression. This model could help physicians make an accurate diagnosis of this progressive and complex disease.

Adolescents on Neuroleptic Medication: Is This Population at Risk for Tardive Dyskinesia?

1998 ◽  
Vol 43 (6) ◽  
pp. 629-631 ◽  
Author(s):  
Stephanie A McDermid ◽  
Jane Hood ◽  
Sandra Bockus ◽  
Enzo D'Alessandro
Keyword(s):  
Risk Factors ◽  
Tardive Dyskinesia ◽  
Chart Review ◽  
Drug Exposure ◽  
Involuntary Movement ◽  
Retrospective Chart Review ◽  
Early Age ◽  
Neuroleptic Medication ◽  
Illness Onset ◽  
Medication Noncompliance

Objective: To assess the incidence of tardive dyskinesia (TD) in a sample of adolescents treated with neuroleptic medication and to identify the presence of any risk factors for TD within the affected group. Method: A retrospective chart review was conducted for 40 cases. The Abnormal Involuntary Movement Scale (AIMS) was used to measure side effects from medication at 6-month intervals over 2 years. Drug exposure was converted to chlorpromazine (CPZ) equivalents and the presence of risk factors for TD, such as a diagnosis of affective disorder, medication noncompliance, early age of illness onset, and concomitant antiparkinsonian medication, was also noted. Results: Of the 40 cases reviewed, 2 patients (5%) met diagnostic criteria for TD, and another 5 patients (12.5%) showed symptoms of TD. Conclusions: TD is a serious risk at any age. Medication noncompliance, early age of illness onset, and concomitant use of antiparkinsonian medication may increase susceptibility to TD and should be carefully monitored.

scholarly journals The Management of Amniotic Fluid Embolism

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Wang X ◽  
◽  
Qi H ◽  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Amniotic Fluid ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Amniotic Fluid Embolism ◽  
Circulatory Support ◽  
Developed Country ◽  
High Risk Factors ◽  
Delayed Recognition

Amniotic Fluid Embolism (AFE) as a devastating complication in obstetrics remains one leading causes of maternal mortality in developed country. During the process of resuscitation, there are some vital deficiencies which mainly involve neglect of high risk factors, delayed recognition of early signs and symptoms, poor knowledge about emergency resuscitation, invalid of management of heart failure, coagulopathy and multi-organ failure. This mini review mainly presented correlative high risk factors, early recognition initial signs or symptoms, and effective therapeutic measures including medicine selection of vasopressors and inotropes, application of Mechanical Circulatory Support (MCS), management of consumptive coagulation, and maintenance of homeostasis.

Clinical trial testing superiority of combination plinabulin (Plin) and pegfilgrastim (Peg) versus peg alone in breast cancer treated with high-risk febrile neutropenia risk chemotherapy (chemo): Final results of the phase 3 protective-2 in chemo-induced neutropenia (CIN) prevention.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 533-533
Author(s):  
Douglas W. Blayney ◽  
Yuankai Shi ◽  
Hryhorii Adamchuk ◽  
David Feng ◽  
Qingyuan Zhang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Safety Profile ◽  
Early Stage ◽  
Standard Of Care ◽  
Primary Objective ◽  
Severe Neutropenia ◽  
Double Blind Study ◽  
Phase 3 ◽  
Double Blind

533 Background: Peg is standard of care (SoC) for the prevention of CIN. Peg’s mechanism of action leaves patients vulnerable to FN in week 1 of the chemo cycle(C), as the absolute neutrophil count (ANC) does not normalize until week 2. Plin is a first-in-class, non-G-CSF small molecule agent, which received breakthrough designation from FDA in CIN. It prevents CIN by protecting progenitor cells in bone marrow from chemo assault and has normal ANC in week 1 (Blayney JAMA Onc 2020). Phase 2 testing showed the combination of Plin and Peg achieved CIN protection throughout the entire cycle vs Peg alone (Blayney: St Gallen 2019, ASCO 2019). Methods: Plin is given on Day (D)1 after Chemo, has a favorable safety profile, and also has anticancer activity. A separate phase 3 study evaluating Plin as an anticancer agent (DUBLIN-3; NCT02504489) in NSCLC pts is underway, with anti-cancer results in OS expected in 2021. In PROTECTIVE-2 (Study 106; NCT0329457), we added Plin (on D1) to Peg (on D2), testing superiority of the combination for CIN prevention vs Peg alone. Study 106, is a global multicenter randomized (1:1) double-blind study to evaluate Plin 40 mg + Peg 6mg (Arm 1) versus Peg 6mg + Placebo (Plac) (Arm 2) in preventing Severe Neutropenia (N), (defined as ANC <0.5 cells × 10E9/L) in early-stage BC (node positive or node negative with a high risk of recurrence) pts. 221 pts with ECOG status 0 or 1 received Docetaxel (75 mg/m2), Doxorubicin (50 mg/m2), and Cyclophosphamide (500 mg/m2) (TAC) on D1 for four 21 D cycles and study treatment. Central laboratory ANC was assessed at Covance in Cycle 1 (C1) on D 1, 2, 3, 6, 7, 8, 9, 10, 11, 12, 13, and 15. Primary objective was to compare the percentage (%) of pts with a Duration of Severe Neutropenia (DSN) of 0 days [that is % of pts with no Grade (Gr) 4 neutropenia (N)] in C1 in each arm. Key secondary endpoints were DSN and ANC Nadir in C1. We also evaluated safety (AE frequency and Grade). Conclusions: Adding Plin to Peg offers superior CIN protection compared to Peg alone and also has a superior safety profile by lowering over 20% of grade 4 AE. The effect size of the CIN protection in the combination is also correlated to clinical meaningful FN reduction compared to peg alone. Clinical trial information: NCT03531099. [Table: see text]

Absolute lymphocyte count in patients with glioblastoma treated with temozolomide chemoradiation.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13564-e13564
Author(s):  
Anas Saeed Bamashmos ◽  
Assad Ali ◽  
Addison Barnett ◽  
Soumya Sagar ◽  
Lisa A. Rybicki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymphocyte Count ◽  
Univariate Analysis ◽  
Methylation Status ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Absolute Lymphocyte Count ◽  
Primary Objective ◽  
Start Date ◽  
Grade 3

e13564 Background: Standard glioblastoma (GBM) management includes radiotherapy, chemotherapy, and steroids; all of which can result in immunosuppression and a low absolute lymphocyte count (ALC). Previous literature identified an association between low CD4 and worse progression free survival (PFS) and overall survival (OS). There remains a lack of research addressing predictors of immunosuppression in patients with GBM. The primary objective of this study is to identify the degree of immunosuppression, measured by ALC, in GBM patients receiving concurrent temozolomide chemoradiation (CRT). Secondary objectives include associations between ALC, PFS, and OS, and whether there are any predictors of immunosuppression in patients with GBM. Methods: We retrospectively reviewed 231 newly diagnosed GBM patients who underwent surgery followed by standard of care CRT. We also analyzed the association between ALC and age, sex, MGMT methylation status, and extent of surgical resection. ALC was collected at the time of surgery, CRT start date, and two, four, six, and ten weeks post-CRT start date. Common Terminology Criteria for Adverse Events (CTCAE) protocol version 5.0 was then used to grade low ALC as grade 0, 1, 2, 3, or 4. Results: Of the 231 patients analyzed, 139 were males, 74 underwent gross total resection of the tumor, 129 patients were less than 65 years, and 79 (42.5%) were MGMT methylated. 37 patients had grade 3-4 low ALC. In a univariate analysis, grade 3-4 low ALC at 4 weeks (±14 days) post-CRT start was associated with higher mortality (HR 1.54, P = 0.028) but had no significant association with PFS (HR 1.22, P = 0.29). Logistic regression analysis was used to identify risk factors for grade 3-4 low ALC and its association with survival. None of the risk factors that we tested such as age, gender, type of surgery, or molecular markers including MGMT, IDH, or EGFR were associated with low ALC. Conclusions: Our study demonstrated that patients with ALC grade 3 or 4 at 4 weeks (±14 days) of CRT had a significantly higher mortality (HR 1.54, P = 0.028) but had no significant association with PFS (HR 1.22, P = 0.29).

scholarly journals An audit of MTP in women with high-risk pregnancy

2021 ◽  
Vol 12 (12) ◽  
pp. 85-90
Author(s):  
Deepali Srivastava ◽  
Sandeepa Srivastava ◽  
Pratibha Kumari ◽  
Deepanshi Srivastava
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Early Recognition ◽  
Unmet Need ◽  
Medical Abortion ◽  
High Risk Group ◽  
High Risk Pregnancy ◽  
Trimester Abortion ◽  
High Risk Factors ◽  
Risk Pregnancy

Background: The women who have been pregnant more than four times are fewer than 18or over 35-years-old, or have at least one medical issue before or during pregnancy, the pregnancy is considered high-risk. Increased maternal and foetal mortality and morbidity are linked to these risk factors. MTP in itself is a blind and risky procedure and performing it in High Risk Pregnancy (HRP) is a challenge for obstetrics and gynecology personnel. When performed with all pre, intra and post-op precautions, results are good and patient-friendly. Aims and Objectives: Aims of the study were to calculate the number, high-risk factors, method used, and its outcome of MTP in HRP. Materials and Methods: The present study was a retrospective observational study done at QMH, KGMU, Lucknow performed on subjects admitted for MTP from January 2018 to December 2018. Total admitted patients seeking MTP were 450 out of which 93 belonged to High-Risk Group who underwent surgical and medical abortion accordingly. All precautions and norms defined by Govt. of India were taken care of. Cases were evaluated on the basis of high-risk factors- Age, parity, obstetrical and medical illnesses, and interval since last delivery. Results: Out of 93 high-risk cases, 88 cases were of 1st trimester and 5 were of 2nd trimester abortion. Six cases required suction evacuation while seven cases were managed medically using medical abortion kit. Contraception was given to all subjects according to their needs. Seventy-one women were of more than 35 yrs, while two were teenagers. 21 women were grand multipara. Women of obstetrical risk were 17 while the rest were having medical illnesses. Conclusion: This study concludes that there are a large number of high-risk groups for MTP again showing unmet need and lack of specialized counseling of HR patients according to their mental and physical condition. Early recognition of pregnancy and timely intervention can be lifesaving in these women and proper contraceptive counseling is required to prevent future pregnancies.

scholarly journals CLINICAL AND SOCIAL RISK FACTORS OF TARDIVE DYSKINESIA IN PATIENTS WITH SCHIZOPHRENIA DURING ANTIPSYCHOTIC TREATMENT

2015 ◽  
Vol 14 (1) ◽  
pp. 32-39
Author(s):  
Ye. G. Kornetova ◽  
A. V. Semke ◽  
Ye. G. Dmitrieva ◽  
Yu. N. Borodyuk ◽  
A. S. Boyko
Keyword(s):  
Risk Factors ◽  
Tardive Dyskinesia ◽  
Negative Symptoms ◽  
Psychiatric Treatment ◽  
Involuntary Movement ◽  
Antipsychotic Treatment ◽  
Social Risk ◽  
Social Risk Factors ◽  
Dynamic Features ◽  
Antipsychotic Therapy

The purpose of the present work was to study the clinical features and risk factors of tardive dyskinesia among     the     schizophrenia     patients     who     durably     receive     the     antipsychotic     therapy. 180 of the 18 to 65 age bracket schizophrenia patients, who were treated in a residential psychiatric treatment facility, were examined with the use of the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and the basic chart of formalized sociodemographic and clinico-dynamic features developed at the Tomsk Mental Health Research Institute. The acquired data were processed by the Mann–Whitney U-Test and χ2. The average age of the tardive dyskinesia patients  turned out to be conclusively older than that of the patients without this derangement. People who have tardive dyskinesia statistically often happen to be single in comparison with other variants of marital status. It was found out that women happen to have tardive dyskinesia more often, which allows us to see the female gender as a risk factor. The tardive dyskinesia patients had certain negative symptoms. The patients were arranged into groups according to the prepotency of symptom-complexes over the subgroups: with orofacial, thoracolumbar and combined tardive dyskinesia. The average age of the orofacial dyskinesia patients turned out to be conclusively older than that of the patients without tardive dyskinesia. The negative symptoms level in the subgroup was conclusively higher than among those without tardive dyskinesia. The average age of the thoracolumbar dyskinesia patients was conclusively older than that of the patients without tardive dyskinesia. The average age of the combined dyskinesia patients was conclusively older than the patients without the tardive dyskinesia. The patients having schizophrenia for longer than 10 years prevailed in the combined dyskinesia group. Such characteristics as education level and social status, age of when the medical problem started, dominance of the positive symptoms, duration of antipsychotic agents administration, somatic condition, use of psychoactive substances, suicidal and hetero-aggressive behaviors make no contribution to the risk of tardive dyskinesia development in the presence of schizophrenia, and they are not protective factors either.

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