Management of psychotropic medications in adults with intellectual disability: a scoping review protocol

Introduction: Psychotropic medications are commonly prescribed among adults with intellectual disability (ID), often in the absence of a psychiatric diagnosis. As such, there is great disparity between the estimated prevalence of mental illness and the rates of psychotropic medication use amongst people with ID. ‘Off-label’ use of these medications may account for much of this discrepancy, in particular their use in the management of challenging behaviour. This has come under scrutiny due to the myriad of side effects and the deficiency of high-quality data supporting their use for this indication. Understanding the causes and justifications for such disparity is essential in discerning the efficacy of current prescription practice. Objective: To explore the existing evidence base regarding the prescription and management of psychotropic medications in adults with ID. The aim will be achieved through identifying the psychotropic medications commonly prescribed, the underlying rationale(s) for their prescription and the evidence available that demonstrates their appropriateness and effectiveness. Additionally, the paper will seek to evaluate the availability of any existing guidance that informs the management of these medications, and the evidence and outcomes of psychotropic medication dose reduction and/or cessation interventions. Inclusion criteria: This review will consider studies that focus on the use of psychotropic medications amongst patients with ID. Methods: Research studies (qualitative, quantitative and mixed design) and Grey Literature (English) will be included. The search will be conducted without time restrictions. Databases will include: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Databased of Systematic Reviews, PsycINFO and Scopus. A three-step search strategy will be followed, with results screened by two independent reviewers. Data will be extracted independently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams.

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Management of psychotropic medications in adults with intellectual disability: a scoping review protocol

HRB Open Research ◽

10.12688/hrbopenres.13170.1 ◽

2021 ◽

Vol 4 ◽

pp. 30

Author(s):

Ashley Costello ◽

Cian Hehir ◽

Drona Sharma ◽

Owen Doody ◽

Dervla Kelly

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Data Extraction ◽

Evidence Synthesis ◽

Grey Literature ◽

Evidence Base ◽

Psychotropic Medications ◽

Quality Data ◽

Cochrane Central Register ◽

Time Restrictions

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Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03371-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yasamin Veziari ◽

Saravana Kumar ◽

Matthew Leach

Keyword(s):

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

Scoping Review ◽

Data Extraction ◽

Grey Literature ◽

Evidence Base ◽

Cochrane Library ◽

Educational Strategies ◽

The Cochrane Library ◽

Complementary And Alternative

Abstract Background Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. Methods The scoping review was undertaken using the Arksey and O’Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. Results Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. Conclusions While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

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Understanding factors critical to the implementation of ehealth in chronic disease management: a realist review protocol

BMJ Open ◽

10.1136/bmjopen-2020-048250 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048250

Author(s):

Nida Shahid ◽

Valeria E Rac ◽

Joanna Bielecki ◽

Whitney Berta

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Data Extraction ◽

Evidence Synthesis ◽

Grey Literature ◽

Complex Interventions ◽

Realist Review ◽

Chronic Obstructive ◽

Multiple Chronic Conditions

IntroductionCanadians are living longer, many with multiple chronic conditions. This population of older, frail Canadians continues to grow in size as do concurrent demands for community-based, outpatient and ambulatory models of care. Ideally, a multifaceted, proactive, planned and integrated care model includes ehealth. Although several factors are known to facilitate the implementation of ehealth in chronic disease management (CDM), for example, adequate support, usability, alignment of programme objectives, there is a growing body of inconclusive evidence on what is critical for implementation. We aim to achieve a fulsome understanding of factors critical to implementation by conducting a realist review—an approach suitable for understanding complex interventions. Our proposed review will identify factors critical to the implementation of ehealth in CDM (heart failure, chronic obstructive pulmonary disease, chronic kidney disease and/or diabetes (type 1 or 2)) without limitations to care setting, language, publication year or geography. Findings will be presented in configurations of contexts, mechanisms and outcomes (CMOs).Methods and analysisA search strategy will be iteratively developed based on the concepts of ‘implementation’ and ‘adoption’ of ‘ehealth’ interventions used within ‘CDM’ to identify the peer-reviewed and grey literature published before 31 March 2021 from five databases (Medline, Embase, Cochrane, CINAHL and PsychInfo) on ehealth interventions actively involving a healthcare provider for CDM among adults. Data extraction and synthesis will be guided by Realist and Meta-review Evidence Synthesis: Evolving Standards (RAMESES) guidelines informing core concepts of CMOs, and a study output will include a middle-range-theory describing the implementation of ehealth in CDM.Ethics and disseminationFindings will be published in an open-access peer-reviewed journal and presented at relevant conferences. A multistakeholder (patients, caregivers, healthcare providers and practitioners, decision-makers and policy-makers) perspective will be used in our dissemination approach. No formal ethics approval is required for this review.PROSPERO registration numberCRD42020208275.

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Psychotropic prescribing practices in adults with intellectual disability and autism spectrum disorder in Richmond Neurodevelpmental Services

BJPsych Open ◽

10.1192/bjo.2021.242 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S76-S76

Author(s):

Anushka Dissanayake ◽

Nicholas Davey ◽

Rupal Patel

Keyword(s):

Autism Spectrum Disorder ◽

Intellectual Disability ◽

Psychotropic Medication ◽

Autism Spectrum ◽

Psychotropic Medications ◽

Spectrum Disorder ◽

Psychiatric Diagnoses ◽

Prescribing Practices ◽

Clinical Records ◽

Challenging Behaviours

AimsOur aim was to evaluate psychotropic prescribing practices in adults with intellectual disability (ID) and autism spectrum disorder (ASD) across the Richmond Neurodevelopmental Service (NDS).Stopping over-medication of people with a learning disability, autism or both with psychotropics (STOMP) aims to reduce the potential harm of inappropriate use of psychotropic medications. We aimed to evaluate our prescribing practices in keeping with STOMP and the NICE guidelines.MethodWe collected information from our clinical records on patients that met the inclusion criteria (≥18 years + diagnosis of ID and autism) from October-November 2019. We gathered the following: age, sex, severity of ID, psychiatric diagnoses, psychotropic medication, presence of challenging behaviours, involvement of positive behaviour support (PBS) and documentation of a PBS plan.Result32 patients met our criteria (3:1 Male-Female ratio with an age range of 20-74 (Median 33 years old)). All 32 patients showed evidence of challenging behaviours. In the cohort, mild ID represented 18.8% (n = 6), moderate ID 40.6% (n = 13) and severe ID 40.6% (n = 13).17 patients (53%) had a PBS plan in place. For those without a PBS plan (47%, n = 15), a referral to behavioural analysis had been considered/requested in 67% (n = 10).31 patients were on psychotropic medication and 84% (n = 26) had an indication documented in the notes although every patient had had a medication review in the last 6 months. 67.7% (n = 21) of the prescriptions were for challenging behaviours.The average number of medications prescribed was 2 (median 2, mean 2.41) but this was reduced to 1 (median 1, mean 1.76) when additional psychiatric diagnoses and epilepsy were excluded.ConclusionPrescriptions are regularly reviewed in keeping with STOMP guidance but there is more scope for utilising behaviour analysis input as well as the need to improve documentation of the rationale for psychotropic medications.

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Remediating doctors’ performance to restore patient safety: a realist review protocol

BMJ Open ◽

10.1136/bmjopen-2018-025943 ◽

2018 ◽

Vol 8 (10) ◽

pp. e025943 ◽

Cited By ~ 2

Author(s):

Tristan Price ◽

Nicola Brennan ◽

Jennifer Cleland ◽

Linda Prescott-Clements ◽

Amanda Wanner ◽

...

Keyword(s):

Patient Safety ◽

Evidence Synthesis ◽

Grey Literature ◽

Realist Review ◽

Evidence Base ◽

Stakeholder Group ◽

Programme Theory ◽

Dissemination Strategy ◽

Knowledge To Action ◽

Patient Representatives

IntroductionUnderperformance by doctors poses a risk to patient safety. Remediation is an intervention designed to remedy underperformance and return a doctor to safe practice. Remediation is widely used across healthcare systems globally, and has clear implications for both patient safety and doctor retention. Yet, there is a poor evidence base to inform remediation programmes. In particular, there is a lack of understanding as to why and how a remedial intervention may work to change a doctor’s practice. The aim of this research is to identify why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to support patient safety.Methods and analysisRealist review is an approach to evidence synthesis that seeks to develop programme theories about how an intervention works to produce its effects. The initial search strategy will involve: database and grey literature searching, citation searching and contacting authors. The evidence search will be extended as the review progresses and becomes more focused on the development of specific aspects of the programme theory. The development of the programme theory will involve input from a stakeholder group consisting of professional experts in the remediation process and patient representatives. Evidence synthesis will use a realist logic of analysis to interrogate data in order to develop and refine the initial programme theory into a more definitive realist programme theory of how remediation works. The study will follow and be reported according to Realist And Meta-narrative Evidence Syntheses—Evolving Standards (RAMESES).Ethics and disseminationEthical approval is not required. Our dissemination strategy will include input from our stakeholder group. Customised outputs will be developed using the knowledge-to-action cycle framework, and will be targeted to: policy-makers; education providers and regulators, the National Health Service, doctors and academics.PROSPERO registration numberCRD42018088779.

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Optimising psychotropic medication use

Tizard Learning Disability Review ◽

10.1108/tldr-07-2017-0031 ◽

2018 ◽

Vol 23 (1) ◽

pp. 22-26

Author(s):

Rory Sheehan

Keyword(s):

Intellectual Disability ◽

Psychotropic Drug ◽

Psychotropic Medication ◽

Psychotropic Drugs ◽

Evidence Base ◽

Research Literature ◽

Collaborative Management ◽

Drug Prescribing ◽

Content Type ◽

Current Concerns

Purpose This commentary accompanies Clare et al.’s study investigating psychotropic drug prescribing for adults with intellectual disability who were referred to specialist community learning disability teams in the east of England. The purpose of this paper is to explore some of the background to psychotropic drug prescribing for people with intellectual disability, review important contextual factors that influence prescribing decisions, and consider how we might make the best use of psychotropic drugs in this group. Design/methodology/approach Narrative summary and opinion, supported by reference to recent research literature. Findings Psychotropic drug use for people with intellectual disability raises complex issues, not least because of the lack of research evidence that exists on the topic. Psychotropic drugs can be an important part of treatment for people with mental illness but further research is needed to support prescribing for challenging behaviour. Medication optimisation is a framework within which individual preferences and values are considered alongside the evidence base and clinical judgement in order to inform safe, effective, and collaborative management decisions. Practical implications Prescribing decisions should be individualised and reviewed regularly, incorporating evidence from patients and carers. Improving the use of psychotropic medication requires concerted action, adequate social support, and the provision of alternative, non-pharmacological interventions that are acceptable and effective. Originality/value This paper reviews some of the current concerns about the use of psychotropic drugs and opens up new avenues of discussion.

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Are developmentally missing teeth a predictive risk marker of malignant diseases in non-syndromic individuals? A systematic review

Journal of Orthodontics ◽

10.1177/1465312520984166 ◽

2021 ◽

pp. 146531252098416

Author(s):

Lubna Al-Muzian ◽

Mohammed Almuzian ◽

Hisham Mohammed ◽

Aman Ulhaq ◽

Alexander J Keightley

Keyword(s):

Data Extraction ◽

Grey Literature ◽

Risk Of Bias ◽

Secondary Outcome ◽

Cochrane Central Register ◽

Study Selection ◽

Central Register ◽

Comprehensive Search ◽

Prostate Cancers ◽

Predictive Risk

Background: Different genes and loci that are associated with non-syndromic developmental tooth agenesis (TA) have the same causation pathway in the development of tumours including breast cancer (BC), epithelial ovarian cancer (EOC), colorectal cancer (CRC) and lung cancer (LC). Objectives: To assess the link between TA and the development of cancer. Search sources: This registered review included a comprehensive search of electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], LILACS, Scopus, Web of Science and Medline via Ovid) until 1 April 2020, supplemented by manual, grey literature and reference lists search. There was no restriction in term of date of publication, gender, race or type of hypodontia. Data selection: The primary outcome was the relationship between TA and cancer. The secondary outcome was to identify the genetic correlation between TA and cancer. Data extraction: Study selection, data extraction and risk of bias assessment were performed independently and induplicate by two reviewers, with disputes resolved by a third reviewer. Results: Eight studies with a moderate-high risk of bias were included in the final review, with a total of 5821 participants. Due to the heterogeneity among the included studies, the data were presented narratively. Limited studies reported a high prevalence of EOC (19.2%–20%) and CRC (82%–100%) in individuals with TA (depending on the study) compared to those without TA (3% for EOC and 0% for CRC). While others reported a weak correlation between EOC and CRC and TA ( P > 0.05). Weak evidence suggested a strong correlation between breast, cervical uterine and prostate cancers and TA ( P < 0.05). Conclusions: Though low-quality evidence suggests a link between TA and cancer, it was not possible to verify that TA can hold a predictive value as a marker for cancers. Further research is needed to confirm the association. Registration: PROSPERO (CRD42020139751).

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Hyaluronic acid for tissue and bone regeneration after tooth extraction. Systematic review and meta-analysis

10.1101/2020.06.02.20120733 ◽

2020 ◽

Author(s):

Shuheng Lai ◽

Francisco Novillo ◽

Geovanna Cárdenas ◽

Francisca Verdugo ◽

Gabriel Rada

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Bone Regeneration ◽

Tooth Extraction ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Controlled Trials ◽

Cochrane Central Register ◽

Eligibility Criteria

AbstractObjectiveThe objective of this systematic review is to assess the effectiveness and safety of Hyaluronic Acid (HA) on tissue and bone regeneration after tooth extraction.Data SourcesWe will conduct a comprehensive search in Epistemonikos, PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, the International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, US National Institutes of Health (NIH) and grey literature, to identify all relevant randomized controlled trials regardless of language or publication status (published, unpublished, in press and in progress).Eligibility Criteria for Selecting Studies and MethodsWe will include randomized trials evaluating the effect of HA on tissue and bone regeneration after tooth extraction. Two reviewers will independently screen each study for eligibility, data extraction, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome.Ethics and DisseminationNo ethics approval is considered necessary. The results of this review will be disseminated via peer-reviewed publications, social networks, and traditional media.PROSPERO Registration IDCRD42020150285

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Appropriateness of psychotropic medication use in a cohort of adolescents with intellectual disability in Queensland, Australia

BJPsych Open ◽

10.1192/bjo.2020.125 ◽

2020 ◽

Vol 6 (6) ◽

Author(s):

Menghuan Song ◽

Robert S. Ware ◽

Tan N. Doan ◽

Lyn McPherson ◽

Julian N. Trollor ◽

...

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Clinical Decision Making ◽

Medical Condition ◽

Inappropriate Prescribing ◽

Medication Use ◽

Psychotropic Medications ◽

Off Label ◽

Inappropriate Use ◽

Challenging Behaviours

Background Psychotropic medications are sometimes used off-label and inappropriately. This may cause harm to adolescents with intellectual disability. However, few studies have analysed off-label or inappropriate prescribing to this group. Aims To examine the appropriateness of psychotropic prescribing to adolescents with intellectual disability living in the community in south-east Queensland, Australia. Method Off-label medication use was determined based on whether the recorded medical condition treated was approved by the Australian Therapeutic Goods Administration. Clinical appropriateness of medication use was determined based on published guidelines and clinical opinion of two authors who specialise in developmental disability medicine (J.N.T. and D.H.). Results We followed 429 adolescents for a median of 4.2 years. A total of 107 participants (24.9%) were prescribed psychotropic medications on at least one occasion. Of these, 88 (82.2%) were prescribed their medication off-label or inappropriately at least once. Off-label or inappropriate use were most commonly associated with challenging behaviours. Conclusions Off-label or inappropriate use of psychotropic medications was common, especially for the management of challenging behaviours. Clinical decision-making accounts for individual patient factors and is made based on clinical experience as well as scientific evidence, whereas label indications are developed for regulatory purposes and, although appropriate at a population level, cannot encompass the foregoing considerations. Education for clinicians and other staff caring for people with intellectual disability, and a patient-centred approach to prescribing with involvement of families should encourage appropriate prescribing. The effect of the National Disability Insurance Scheme on the appropriateness of psychotropic medication prescribing should be investigated.

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The role of organizational and professional cultures in medication safety: a scoping review of the literature

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzz111 ◽

2019 ◽

Vol 31 (10) ◽

pp. G146-G157 ◽

Cited By ~ 1

Author(s):

Samantha Machen ◽

Yogini Jani ◽

Simon Turner ◽

Martin Marshall ◽

Naomi J Fulop

Keyword(s):

Scoping Review ◽

Medication Safety ◽

Local Governance ◽

Data Extraction ◽

Grey Literature ◽

Evidence Base ◽

Original Research ◽

The Impact ◽

Governance Arrangements

ABSTRACT Purpose This scoping review explores what is known about the role of organizational and professional cultures in medication safety. The aim is to increase our understanding of ‘cultures’ within medication safety and provide an evidence base to shape governance arrangements. Data sources Databases searched are ASSIA, CINAHL, EMBASE, HMIC, IPA, MEDLINE, PsycINFO and SCOPUS. Study selection Inclusion criteria were original research and grey literature articles written in English and reporting the role of culture in medication safety on either organizational or professional levels, with a focus on nursing, medical and pharmacy professions. Articles were excluded if they did not conceptualize what was meant by ‘culture’ or its impact was not discussed. Data extraction Data were extracted for the following characteristics: author(s), title, location, methods, medication safety focus, professional group and role of culture in medication safety. Results of data synthesis A total of 1272 citations were reviewed, of which, 42 full-text articles were included in the synthesis. Four key themes were identified which influenced medication safety: professional identity, fear of litigation and punishment, hierarchy and pressure to conform to established culture. At times, the term ‘culture’ was used in a non-specific and arbitrary way, for example, as a metaphor for improving medication safety, but with little focus on what this meant in practice. Conclusions Organizational and professional cultures influence aspects of medication safety. Understanding the role these cultures play can help shape both local governance arrangements and the development of interventions which take into account the impact of these aspects of culture.

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