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McInerney BE, Cross AJ, Alderman CP, Bhat R, Boyd CM, Brandt N, Cossette B, Desforges K, Dowd LA, Frank C, Hartikainen S, Herrmann N, Hilmer SN, Jack L, Jordan S, Kitamura CR, Koujiya E, Lampela P, Macfarlane S, Manias E, Martin C, Martínez-Velilla N, Moriarty F, Onder G, Quirke T, Silvius JL, Soulsby N, Stafford AC, Steinman MA, Sun W, Taguchi R, Todd A, Trenaman SC, Yap KZ, Zhao M, Bell JS, Turner JP. Top 10 Signs and Symptoms of Psychotropic Adverse Drug Events to Monitor in Residents of Long-Term Care Facilities. J Am Med Dir Assoc 2024; 25:105118. [PMID: 38950588 DOI: 10.1016/j.jamda.2024.105118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To produce a consensus list of the top 10 signs and symptoms suggestive of adverse drug events (ADEs) for monitoring in residents of long-term care facilities (LTCFs) who use antipsychotics, benzodiazepines, or antidepressants. DESIGN A 3-round Delphi study. SETTING AND PARTICIPANTS Geriatricians, psychiatrists, pharmacologists, general practitioners, pharmacists, nurses, and caregivers from 13 Asia Pacific, European, and North American countries. METHODS Three survey rounds were completed between April and June 2023. In Round 1, participants indicated their level of agreement on a 9-point Likert scale on whether 41 signs or symptoms identified in a systematic review should be routinely monitored. Participants considered signs and symptoms that reduce quality of life or cause significant harm, are observable or measurable by nurses or care workers, and can be assessed at a single time point. Round 1 statements were included in a list for prioritization in Round 3 if ≥ 70% of participants responded ≥7 on the Likert scale. Statements were excluded if ≤ 30% of participants responded ≥7. In Round 2, participants indicated their level of agreement with statements that did not reach initial consensus, plus amended statements based on Round 1 participant feedback. Round 2 statements were included in Round 3 if ≥ 50% of the participants responded ≥7 on the Likert scale. In Round 3, participants prioritized the signs and symptoms. RESULTS Forty-four participants (93.6%) completed all 3 rounds. Four of 41 signs and symptoms reached consensus for inclusion after Round 1, and 9 after Round 2. The top 10 signs and symptoms prioritized in Round 3 were recent falls, daytime drowsiness or sleepiness, abnormal movements (eg, shaking or stiffness), confusion or disorientation, balance problems, dizziness, postural hypotension, reduced self-care, restlessness, and dry mouth. CONCLUSIONS AND IMPLICATIONS The top 10 signs and symptoms provide a basis for proactive monitoring for psychotropic ADEs.
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Affiliation(s)
- Brigid E McInerney
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | | | - Ravi Bhat
- Department of Rural Health, The University of Melbourne, Melbourne, Australia
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - Nicole Brandt
- Lamy Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Benoit Cossette
- Faculte de medecine et des sciences de la sante, Universite de Sherbrooke, Canada
| | | | - Laura A Dowd
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Chris Frank
- Department of Medicine, Queen's University, Kingston, Canada
| | - Sirpa Hartikainen
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Sarah N Hilmer
- Kolling Institute, Northern Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Leanne Jack
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Australia
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, United Kingdom
| | | | - Eriko Koujiya
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Pasi Lampela
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Stephen Macfarlane
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elizabeth Manias
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christine Martin
- Advocate and Caregiver for Relative in Residential Care, North Vancouver, British Columbia, Canada
| | - Nicolás Martínez-Velilla
- Navarre Health Service (SNS-O), Navarre University Hospital (HUN), Department of Geriatrics, Navarrabiomed, Navarre Public University (UPNA), Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Graziano Onder
- Department of Geriatrics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Tara Quirke
- Dementia Training Study Centre, University of Wollongong, Queensland, Australia
| | - James L Silvius
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrew C Stafford
- Curtin Medical School & enAble Institute, Curtin University, Perth, Australia
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Reina Taguchi
- Research Department, Institute for Health Economics and Policy, Tokyo, Japan
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle, United Kingdom
| | - Shanna C Trenaman
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Kai Zhen Yap
- Faculty of Science, Department of Pharmacy and Pharmaceutical Sciences, National University of Singapore, Singapore
| | - Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Justin P Turner
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Azargoonjahromi A. Current Findings and Potential Mechanisms of KarXT (Xanomeline-Trospium) in Schizophrenia Treatment. Clin Drug Investig 2024; 44:471-493. [PMID: 38904739 DOI: 10.1007/s40261-024-01377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
Standard schizophrenia treatment involves antipsychotic medications that target D2 dopamine receptors. However, these drugs have limitations in addressing all symptoms and can lead to adverse effects such as motor impairments, metabolic effects, sedation, sexual dysfunction, cognitive impairment, and tardive dyskinesia. Recently, KarXT has emerged as a novel drug for schizophrenia. KarXT combines xanomeline, a muscarinic receptor M1 and M4 agonist, with trospium, a nonselective antimuscarinic agent. Of note, xanomeline can readily cross blood-brain barrier (BBB) and, thus, enter into the brain, thereby stimulating muscarinic receptors (M1 and M4). By doing so, xanomeline has been shown to target negative symptoms and potentially improve positive symptoms. Trospium, on the other hand, is not able to cross BBB, thereby not affecting M1 and M4 receptors; instead, it acts as an antimuscarinic agent and, hence, diminishes peripheral activity of muscarinic receptors to minimize side effects probably stemming from xanomeline in other organs. Accordingly, ongoing clinical trials investigating KarXT's efficacy in schizophrenia have demonstrated positive outcomes, including significant improvements in the Positive and Negative Syndrome Scale (PANSS) total score and cognitive function compared with placebo. These findings emphasize the potential of KarXT as a promising treatment for schizophrenia, providing symptom relief while minimizing side effects associated with xanomeline monotherapy. Despite such promising evidence, further research is needed to confirm the efficacy, safety, and tolerability of KarXT in managing schizophrenia. This review article explores the current findings and potential mechanisms of KarXT in the treatment of schizophrenia.
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Affiliation(s)
- Ali Azargoonjahromi
- Shiraz University of Medical Sciences, Janbazan Blv, 14th Alley, Jahrom, Shiraz, 7417773539, Fars, Iran.
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Zhang X, Saif MJ, Idrees N, Kanwal S, Parveen S, Saeed F. QSPR Analysis of Drugs for Treatment of Schizophrenia Using Topological Indices. ACS OMEGA 2023; 8:41417-41426. [PMID: 37970009 PMCID: PMC10633864 DOI: 10.1021/acsomega.3c05000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023]
Abstract
Schizophrenia is a chronic psychotic disorder characterized primarily by cognitive deficits. Drugs and therapies are helpful in managing the symptoms, mostly with long-term compliance. There is a pressing need to design more efficient drugs with fewer adverse effects. Solubility, metabolic stability, toxicity, permeability, and transporter effects are important parameters in the efficacy of drug design, which in turn depend upon different physical and chemical characteristics of drugs. In recent years, there has been growing interest in developing computational tools for the discovery and development of drugs for schizophrenia. Some of these methods use machine learning algorithms to predict the efficacy and side effects of the potential drugs. Other studies have used computer simulations to understand the molecular mechanisms underlying the disease and identify new targets for drug development. Topological indices are numeric quantities linked to the chemical structure of drugs and predict the properties, reactivity, and stability of drugs through the quantitative structure-property relationship (QSPR). This work is aimed at using statistical techniques to link QSPR correlating properties with connectivity indices using linear regression. The QSPR model gives quite a better estimation of the properties of drugs, such as melting point, boiling point, enthalpy, flash point, molar refractivity, refractive index, complexity, molecular weight, and refractivity. Results are validated by comparing actual values to estimated values for the drugs.
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Affiliation(s)
- Xiujun Zhang
- School
of Computer Science, Chengdu University, Chengdu 610106, China
| | - Muhammad Jawwad Saif
- Department
of Applied Chemistry, Government College
University Faisalabad, Faisalabad 38000, Pakistan
| | - Nazeran Idrees
- Department
of Mathematics, Government College University
Faisalabad, Faisalabad 38000, Pakistan
| | - Salma Kanwal
- Department
of Mathematics, Lahore College for Women
University, Lahore 54000, Pakistan
| | - Saima Parveen
- Department
of Mathematics, Government College University
Faisalabad, Faisalabad 38000, Pakistan
| | - Fatima Saeed
- Department
of Mathematics, Government College University
Faisalabad, Faisalabad 38000, Pakistan
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McInerney BE, Cross AJ, Turner JP, Bell JS. Systematic Review of Psychotropic Adverse Drug Event Monitoring Tools for Use in Long-Term Care Facilities. J Am Med Dir Assoc 2023:S1525-8610(23)00282-7. [PMID: 37037347 DOI: 10.1016/j.jamda.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To evaluate properties of psychotropic adverse drug event (ADE) monitoring tools intended for use in long-term care facilities. DESIGN Systematic review. SETTING AND PARTICIPANTS Adults aged 18 years and older in nursing homes and other long-term care facilities. METHODS Medline, CINAHL, Embase, and PsycInfo were searched from inception to August 2022 for studies reporting the development, validation, or application of tools to monitor psychotropic ADEs. Screening, data extraction, and quality assessment were performed independently by 2 authors. Each tool was assessed under the domains of test-retest reliability, interrater reliability, content validity, and construct validity. RESULTS Eight studies that described 6 tools were included. Tools were developed in Wales (n = 2), United States (n = 1), Ireland (n = 1), Canada (n = 1), and Singapore (n = 1). Tools monitored 4 to 95 items related to antipsychotics (n = 6 tools), antidepressants (n = 4), benzodiazepines or hypnotics (n = 4), antiepileptics (n = 4), and dementia medications (n = 1). Tools commonly monitored sedation, tiredness, or sleepiness (n = 6); falls (n = 4); and tremor or extrapyramidal symptoms (n = 4). Tools were designed for application by nurses (n = 4), during family conferences (n = 1), and by general medical practitioners before repeat prescribing (n = 1). Two tools were reported to require 10 to 60 minutes to administer. Four tools were determined to have adequate content validity and 2 tools adequate interrater reliability. No tools reported test-retest reliability or construct validity. CONCLUSIONS AND IMPLICATIONS Six published psychotropic ADE monitoring tools are heterogeneous in design and intended application. Existing tools are predominately designed for application by nurses with or without direct involvement of the wider multidisciplinary team. Further research is needed into models of care that facilitate psychotropic ADE monitoring in the long-term care facility setting, and the extent to which application of specific tools is associated with reduced medication-related harm.
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Affiliation(s)
- Brigid E McInerney
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Justin P Turner
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Faculty of Pharmacy, University of Montreal, Quebec, Canada
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
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Ghaddar Z, Matar N, Noujaim J, Diep AN, Tohmé A, Pétré B. Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study. Patient Prefer Adherence 2022; 16:1511-1524. [PMID: 35769338 PMCID: PMC9236548 DOI: 10.2147/ppa.s364520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). Methods We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. Results Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority. Conclusion This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.
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Affiliation(s)
- Zahya Ghaddar
- Department of Public Health, University of Liège, Liege, Belgium
- Doctoral School of Sciences and Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Nayla Matar
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Joyce Noujaim
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Anh Nguyet Diep
- Department of Public Health, University of Liège, Liege, Belgium
| | - Aline Tohmé
- Department of Internal Medicine and Clinical Immunology, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liege, Belgium
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Walsh KA, Timmons S, Byrne S, Browne J, Mc Sharry J. Identifying behavior change techniques for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. Transl Behav Med 2021; 11:470-483. [PMID: 32589204 DOI: 10.1093/tbm/ibaa053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Nursing home residents with dementia are commonly prescribed antipsychotics despite the associated increased risk of harms. Interventions to optimize prescribing practice have been found to be effective in the short term, but there is a lack of evidence to support sustainability of effects, along with a lack of theory, public involvement, and transparency in the intervention development process. Using theory has been advocated as a means of improving intervention sustainability. The aim of this study was, therefore, to identify behavior change techniques (BCTs) for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. A comprehensive approach to identifying a long list of all potential BCTs from three different sources was undertaken. The most appropriate BCTs were then selected through a two-round Delphi consensus survey with a broad range of experts (n = 18 panelists). Advisory groups of people with dementia, family carers, and professional stakeholders provided feedback on the final BCTs included. After two Delphi survey rounds, agreement was reached on 22 BCTs. Further refinement of the selected BCTs based on advisory group and panelists' feedback, along with use of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects/safety, and Equity) resulted in a final list of 16 BCTs. The next step in intervention development will be to identify the most appropriate mode of delivery of the 16 BCTs identified for inclusion. The study provides a case example of a systematic approach to incorporating evidence with stakeholder views in the identification of appropriate BCTs.
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Affiliation(s)
- Kieran A Walsh
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.,Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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Abd El-Hameed AM, Eskandrani AA, Elroby FA. Assessment of the ameliorative effect of Hypericum perforatum on olanzapine-induced hepatic oxidative stress and metabolic abnormalities in experimental male albino rats. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2020. [DOI: 10.1080/16583655.2020.1834757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Abeer M. Abd El-Hameed
- Faculty of Science, Chemistry Department, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Areej A. Eskandrani
- Faculty of Science, Chemistry Department, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Fadwa A. Elroby
- Faculty of Medicine, Forensic Medicine &Toxicology Department, Beni-Suef University, Egypt
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