Quality prescribing in early psychosis: key pharmacotherapy principles

2021 ◽  
pp. 103985622110546
Author(s):  
James G Scott ◽  
Gemma McKeon ◽  
Eva Malacova ◽  
Jackie Curtis ◽  
Bjorn Burgher ◽  
...  
Keyword(s):  
Patient Choice ◽  
Early Psychosis ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Metabolic Monitoring ◽  
Risk Benefit Assessment ◽  
Medication Risk ◽  
Long Acting ◽  
Informed Patient ◽  
Medication Choice

Objective: To present a practical, easy-to-implement clinical framework designed to support evidence-based quality prescribing for people with early psychosis. Method: Identification and explanation of key principles relating to evidence-based pharmacotherapy for people with early psychosis. These were derived from the literature, practice guidelines and clinical experience. Results: Key principles include (1) medication choice informed by adverse effects; (2) metabolic monitoring at baseline and at regular intervals; (3) comprehensive and regular medication risk–benefit assessment and psychoeducation; (4) early consideration of long-acting injectable formulations (preferably driven by informed patient choice); (5) identification and treatment of comorbid mood disorders and (6) early consideration of clozapine when treatment refractory criteria are met. Conclusions: Current prescribing practices do not align with the well-established evidence for quality pharmacotherapy in early psychosis. Adopting evidence-based prescribing practices for people with early psychosis will improve outcomes.

scholarly journals A Modest Proposal for Restoration Ecology

2020 ◽  
Author(s):  
Cameron Brick
Keyword(s):  
Public Opinion ◽  
Ecosystem Services ◽  
Native Species ◽  
Restoration Ecology ◽  
Environmental Policies ◽  
Patient Choice ◽  
Evidence Based ◽  
Policy Options ◽  
Modest Proposal ◽  
Informed Patient

Restoration ecology struggles to mitigate human-caused ecological damage. Non-native species are a particular challenge. This article describes two restoration attempts following introduced species in California and then makes a radical culling proposal. Environmental regulations, legal protections, and restoration projects are necessary to preserve ecosystem services, but such policies are often unpopular. Restorers often struggle when public opinion opposes evidence-based practice, and this occurs particularly when the interventions involve killing mammals. Therefore, restoration efforts may benefit from more attention to how individuals perceive the acceptability of environmental policies and how to communicate policy options effectively for individuals to make informed decisions. Restoration ecology can follow the recent shift of medicine away from imperatives and towards informed patient choice. Restoration projects may benefit from recent advances in psychology and communication that help individuals make policy decisions that align with their personal values.

Prescribing practices in psychiatric hospitals in Eastern Europe

2011 ◽  
Vol 26 (7) ◽  
pp. 414-418 ◽  
Author(s):  
V. Jordanova ◽  
N.P. Maric ◽  
V. Alikaj ◽  
M. Bajs ◽  
T. Cavic ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Western Europe ◽  
Atypical Antipsychotics ◽  
Psychiatric Care ◽  
Anticholinergic Drug ◽  
Psychiatric Hospitals ◽  
Evidence Based ◽  
Prescribing Practices ◽  
The Mean ◽  
Clinical Records

AbstractBackgroundThere has been no evidence about the prescribing practices in psychiatric care in Eastern Europe.AimsTo examine the patterns of psychotropic prescribing in five countries of Eastern Europe.MethodWe conducted a one-day census of psychiatric treatments used in eight psychiatric hospitals in Albania, Croatia, Macedonia, Serbia and Romania. We examined clinical records and medication charts of 1304 patients.ResultsThe use of polypharmacy was frequent across all diagnostic groups. Only 6.8% of patients were on monotherapy. The mean number of prescribed drugs was 2.8 (SD 0.97) with 26.5% receiving two drugs, 42.1% receiving three drugs and 22.1% being prescribed four or more psychotropic drugs. Typical antipsychotics were prescribed to 63% and atypical antipsychotics to 40% of patients with psychosis. Older generations of antidepressants were prescribed to 29% of patients with depression. Anxiolitic drugs were prescribed to 20.4% and benzodiazepines to 68.5% of patients. One third of patients received an anticholinergic drug on a regular basis.ConclusionsOlder generation antipsychotics and antidepressants were used more frequently than in the countries of Western Europe. Psychotropic polypharmacy is a common practice. There is a need for adopting more evidence-based practice in psychiatric care in these countries.

Feasibility barriers and effectiveness of specific treatments for early psychosis in routine mental health care

2011 ◽  
Vol 26 (S2) ◽  
pp. 2042-2042
Author(s):  
M. Ruggeri
Keyword(s):  
Psychosocial Interventions ◽  
Early Psychosis ◽  
Control Group ◽  
Routine Practice ◽  
Evidence Based ◽  
Roles And Responsibilities ◽  
Or Practice ◽  
Representative Samples ◽  
Poor Management

IntroductionIssues of organisational structure and commitment, resource development, and clarity of roles and responsibilities must be addressed before proceeding with any attempt to implement evidence based interventions in a specific service.Evidence suggests that the management of most mental disorders and especially of psychoses is frequently suboptimal. This trend might reflect instances of inadequate resource allocation, but might also reflect the effects of stigma, discrimination, and social exclusion that people with psychosis often experience. It might also indicate poor management of available resources or deficiencies in knowledge or practice.AimsMulti-element psychosocial interventions in the first 5 years from psychosis onset have proved to facilitating recovery and reducing long-term disability. However, most studies often do not test efficacy against a control group and have been conducted in non-epidemiologically representative samples. The presentation will be focussed on process of assessment of acceptability and discrepancies between evidence and clinical practice in the treatment of schizophrenia in community care.Methods and ResultsTrials - such as the GET UP Trial (National Coordinator: Mirella Ruggeri) that is part of the Strategic Research Programs of the Italian Government - that are being conducted in the routine practice and that aim to test the feasibility and cost-effectiveness of evidence-based psychosocial interventions will be presented and discussed.ConclusionsVerify the barriers to application and situations when evidence-based interventions practice might be ineffective or inappropriate, understanding their advantages and limitations is a crucial challenge in the area of early psychosis treatment.

scholarly journals A Controlled, Evidence-Based Trial of Paliperidone Palmitate, A Long-Acting Injectable Antipsychotic, in Schizophrenia

2010 ◽  
Vol 35 (10) ◽  
pp. 2072-2082 ◽  
Author(s):  
Henry A Nasrallah ◽  
Srihari Gopal ◽  
Cristiana Gassmann-Mayer ◽  
Jorge A Quiroz ◽  
Pilar Lim ◽  
...  
Keyword(s):  
Paliperidone Palmitate ◽  
Evidence Based ◽  
Long Acting

scholarly journals Breast implants: evidence based patient choice and litigation

BMJ ◽  
1999 ◽  
Vol 318 (7181) ◽  
pp. 414-414 ◽  
Author(s):  
J A M. Gray
Keyword(s):  
Breast Implants ◽  
Patient Choice ◽  
Evidence Based

Postoperative Opioid Prescribing Practices and Evidence-Based Guidelines in Bariatric Surgery

2019 ◽  
Vol 29 (7) ◽  
pp. 2030-2036 ◽  
Author(s):  
Danielle T. Friedman ◽  
Saber Ghiassi ◽  
Matthew O. Hubbard ◽  
Andrew J. Duffy
Keyword(s):  
Bariatric Surgery ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Evidence Based Guidelines

scholarly journals Prevention of COPD exacerbations: medications and other controversies

2015 ◽  
Vol 1 (1) ◽  
pp. 00011-2015 ◽  
Author(s):  
Jørgen Vestbo ◽  
Peter Lange
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Short Review ◽  
Chronic Obstructive ◽  
Evidence Based ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Different Types ◽  
Inflammatory Drugs ◽  
Long Acting

Exacerbations have significant impact on the morbidity and mortality of patients with chronic obstructive pulmonary disease. Most guidelines emphasise prevention of exacerbations by treatment with long-acting bronchodilators and/or anti-inflammatory drugs. Whereas most of this treatment is evidence-based, it is clear that patients differ regarding the nature of exacerbations and are likely to benefit differently from different types of treatment. In this short review, we wish to highlight this, suggest a first step in differentiating pharmacological exacerbation prevention and call for more studies in this area. Finally, we wish to highlight that there are perhaps easier ways of achieving similar success in exacerbation prevention using nonpharmacological tools.

scholarly journals P113: Examining emergency physicians’ self-reported opioid prescribing practices for the treatment of acute pain: A Newfoundland perspective

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S105-S106
Author(s):  
P. Doran ◽  
G. Sheppard ◽  
B. Metcalfe
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Oral Morphine ◽  
Prescribing Patterns ◽  
Evidence Based ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Ensure Patient Safety ◽  
Evidence Based Guidelines

Introduction: Canadians are the second largest consumers of prescription opioids per capita in the world. Emergency physicians tend to prescribe stronger and larger quantities of opioids, while family physicians write the most opioid prescriptions overall. These practices have been shown to precipitate future dependence, toxicity and the need for hospitalization. Despite this emerging evidence, there is a paucity of research on emergency physicians’ opioid prescribing practices in Canada. The objectives of this study were to describe our local emergency physicians’ opioid prescribing patterns both in the emergency department and upon discharge, and to explore factors that impact their prescribing decisions. Methods: Emergency physicians from two urban, adult emergency departments in St. John's, Newfoundland were anonymously surveyed using a web-based survey tool. All 42 physicians were invited to participate via email during the six-week study period and reminders were sent at weeks two and four. Results: A total of 21 participants responded to the survey. Over half of respondents (57.14%) reported that they “often” prescribe opioids for the treatment of acute pain in the emergency department, and an equal number of respondents reported doing so “sometimes” at discharge. Eighty-five percent of respondents reported most commonly prescribing intravenous morphine for acute pain in the emergency department, and over thirty-five percent reported most commonly prescribing oral morphine upon discharge. Patient age and risk of misuse were the most frequently cited factors that influenced respondents’ prescribing decisions. Only 4 of the 22 respondents reported using evidence-based guidelines to tailor their opioid prescribing practices, while an overwhelming majority (80.95%) believe there is a need for evidence-based opioid prescribing guidelines for the treatment of acute pain. Sixty percent of respondents completed additional training in safe opioid prescribing, yet less than half of respondents (42.86%) felt they could help to mitigate the opioid crisis by prescribing fewer opioids in the emergency department. Conclusion: Emergency physicians frequently prescribe opioids for the treatment of acute pain and new evidence suggests that this practice can lead to significant morbidity. While further research is needed to better understand emergency physicians’ opioid prescribing practices, our findings support the need for evidence-based guidelines for the treatment of acute pain to ensure patient safety.

scholarly journals Antibiotics and Facial Fractures: Evidence-Based Recommendations Compared with Experience-Based Practice

2015 ◽  
Vol 8 (1) ◽  
pp. 64-78 ◽  
Author(s):  
Gerhard S. Mundinger ◽  
Daniel E. Borsuk ◽  
Zachary Okhah ◽  
Michael R. Christy ◽  
Branko Bojovic ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Facial Fracture ◽  
Prescribing Practices ◽  
Orbital Surgery ◽  
Level Of Evidence ◽  
Fracture Management ◽  
Mandible Fractures

Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents ( n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices.

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