84,052 research outputs found

    Long-term functional improvements in the 2-year treatment of schizophrenia outpatients with olanzapine long-acting injection 

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    BACKGROUND: Little is known about the long-term changes in the functioning of schizophrenia patients receiving maintenance therapy with olanzapine long-acting injection (LAI), and whether observed changes differ from those seen with oral olanzapine. METHODS: This study describes changes in the levels of functioning among outpatients with schizophrenia treated with olanzapine-LAI compared with oral olanzapine over 2 years. This was a secondary analysis of data from a multicenter, randomized, open-label, 2-year study comparing the long-term treatment effectiveness of monthly olanzapine-LAI (405 mg/4 weeks; n=264) with daily oral olanzapine (10 mg/day; n=260). Levels of functioning were assessed with the Heinrichs-Carpenter Quality of Life Scale. Functional status was also classified as 'good', 'moderate', or 'poor', using a previous data-driven approach. Changes in functional levels were assessed with McNemar's test and comparisons between olanzapine-LAI and oral olanzapine employed the Student's t-test. RESULTS: Over the 2-year study, the patients treated with olanzapine-LAI improved their level of functioning (per Quality of Life total score) from 64.0-70.8 (P<0.001). Patients on oral olanzapine also increased their level of functioning from 62.1-70.1 (P<0.001). At baseline, 19.2% of the olanzapine-LAI-treated patients had a 'good' level of functioning, which increased to 27.5% (P<0.05). The figures for oral olanzapine were 14.2% and 24.5%, respectively (P<0.001). Results did not significantly differ between olanzapine-LAI and oral olanzapine. CONCLUSION: In this 2-year, open-label, randomized study of olanzapine-LAI, outpatients with schizophrenia maintained or improved their favorable baseline level of functioning over time. Results did not significantly differ between olanzapine-LAI and oral olanzapine

    Behaviour of carbon dioxide and water vapour flux densities from a disturbed raised peat bog

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    Measurements of carbon dioxide and water vapour flux densities were carried out for a disturbed raised peat bog in the north of the Netherlands during an 18 month continuous experiment. Tussock grass (sp. Molinea caerulae) mainly dominated the vegetation of the bog area. The maximum leaf area index (LAI) of the vegetation reached a numerical value of about 1.7 in mid-August. When the LAI is large enough (LAI > 0.2), a mean net uptake of carbon dioxide is observed with a clear daily pattern. The total evapotranspiration consists of a soil, an open water, and a plant transpiration part. When the LAI is large enough (LAI > 0.2), plant transpiration dominates the total evapotranspiration. The mean daily transpiration pattern, however, is not similar to the carbon dioxide uptake pattern. During the summer months, the daytime carbon dioxide uptake shows a single early morning maximum value followed by a decline in uptake during the rest of the day. The evapotranspiration, however, follows more or less the incoming short-wave radiation pattern. Effects of the vapour pressure deficit are suggested as a possible cause of this discrepanc

    Determining fPAR and leaf area index of several land cover classes in the Pot River and Tsitsa River catchments of the Eastern Cape, South Africa

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    Determining the quantum (both annual maxima and minima) and the temporal variation in the leaf area index (LAI), and the fraction of photosynthetically active radiation (fPAR), are three fundamental biophysical characteristics of the plant canopy that should parameterise ecophysiological models of water use (evapotranspiration) and carbon sequestration. Although Earth observation provides values and time series for both these parameters, in-field validation of these values is necessary. Following a very wet summer season, we conducted field surveys of several land cover classes within two quaternary catchments in the Eastern Cape province, South Africa, to determine maximum values of LAI and fPAR that occur within each of these land cover classes. To assist in up-scaling these point measures to the landscape, we present a regression relationship between Landsat 8 NDVI and LAI measured using an Accupar Ceptometer (r2 = 0.92). Peak wet season LAI varied from extremely high (&gt;7.0) under the canopy of invasive black wattle (Acacia mearnsii) trees to ~2.0 under the canopy of a Eucalyptus plantation. Ungrazed native grassland displayed an intermediate LAI value of 3.84. The black wattle stand absorbed 97% of the available PAR, whereas the mature Eucalyptus plantation only absorbed 66% of PAR.Keywords: agroforestry, ecosystem ecology, remote sensin

    The cost associated with administering risperidone long-acting injections in the Australian community

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    <p>Abstract</p> <p>Background</p> <p>Risperidone long-acting injection (LAI) is mostly administered twice weekly to people with schizophrenia by nurses at community mental health centres (CMHC) or through mobile outreach visits. This study estimates the cost of resource utilisation associated with the administration of risperidone LAI and the potential savings from substituting two-weekly injections with a longer interval product of therapeutic equivalence.</p> <p>Methods</p> <p>A survey of mental health staff overseeing the administration of risperidone LAI at 253 distinct Australian CMHCs was undertaken in November 2009. For the two-week period prior to the survey, respondents were asked questions on injection time (and related tasks) and, for mobile outreach visits, distance and time travelled as well as reduction in visits. Results were stratified by Australian Standard Geographical Classification (ASGC) region. Resource use was quantified and valued in Australian dollars.</p> <p>Results</p> <p>Results are derived from 74 CMHCs, representing approximately 26% of the national average risperidone LAI unit two-week sales. Stratified average injection time (including related tasks) for risperidone LAI ranged from 18-29 minutes, with a national average of 20.12 minutes. For mobile outreach visits, average distance per patient ranged from 19.4 to 55.5 km for One Staff Visits and 15.2 to 218.1 km for More Than One Staff Visits, and average time travelled ranged from 34.1 to 54.5 minutes for One Staff Visits and 29.2 to 136.3 minutes for More Than One Staff visits. The upper range consistently reflected greater resource utilisation in rural areas compared to urban areas. If administration of risperidone LAI had not been required, 20% fewer mobile outreach visits would have occurred.</p> <p>Conclusions</p> <p>The national average saving per two-weekly risperidone long-acting injection avoided is 75.14.In2009inAustralia,thiswouldhavesaved 75.14. In 2009 in Australia, this would have saved ~11 million for injection administration costs alone if all patients taking two-weekly risperidone LAI had instead been treated with a therapeutically equivalent long-acting injectable antipsychotic requiring one less injection per month.</p

    Long-acting injectable versus daily oral antipsychotic treatment trials in schizophrenia: pragmatic versus explanatory study designs

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    Trial design characteristics related to the explanatory:pragmatic spectrum may contribute toward the inconsistent results reported in studies comparing long-acting injectable (LAI) versus daily oral antipsychotic (AP) treatments in schizophrenia. A novel approach examined the hypothesis that a more pragmatic design is important to show the advantages of LAI versus oral APs. A literature search identified comparative studies assessing the clinical efficacy/effectiveness of LAI versus oral APs in more than 100 schizophrenia patients, with 6-month or more duration/follow-up, and published between January 1993 and December 2013 (n=11). Each study\u27s design was rated using the six-domain ASPECT-R (A Study Pragmatic:Explanatory Characterization Tool-Rating). Nonparametric Wilcoxon rank-sum tests compared ratings of studies supporting (n=7) and not supporting (n=4) a LAI advantage. ASPECT-R total and domain scores were significantly higher (more pragmatic) in studies finding a LAI versus oral AP treatment advantage than those that did not. The rank order of this significance among domains was as follows: participant compliance assessment\u27 (P=0.005), medical practice setting/practitioner expertise\u27 (P=0.006), intervention flexibility\u27 (P=0.007), follow-up intensity/duration\u27 (P=0.009), primary trial outcomes\u27 (P=0.012), and participant eligibility\u27 (P=0.015). Findings support that more pragmatic, less explanatory design features are important to show advantages for LAI treatment. Explanatory studies may introduce features that obscure advantages related to adherence

    PMH26 - comparing healthcare resource utilization and costs among schizophrenic patients who initiated typical vs. atypical long-acting injectables in the us veteran population

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    Onur Başer (MEF Author)OBJECTIVES: To evaluate healthcare resource utilization and costs among schizophrenic patients who initiated typical and atypical long-acting injectables (LAIs) inthe U.S. veteran population. METHODS: Using the Veterans Health Administration(VHA) Medical SAS datasets, patients with ?1 pharmacy claim for LAIs were identified from 01OCT2005 through 30SEPT2012. The first LAI date was designated asthe index date. Patients were required to be age ?18 years, have continuous healthplan enrollment for 12 months pre-index date and a schizophrenia diagnosis(International Classification of Diseases, 9th Revision, Clinical Modification [ICD9-CM] code 295.xx) during the study period. Patient data was observed until theearlier date of death or the end of the study period, and patients were assigned totypical LAI (fluphenazine, haloperidol, perphenazine) or atypical LAI (aripiprazole,olanzapine, paliperidone, risperidone) antipsychotic cohorts. All-cause (follow-up)and psychiatric disorder-related healthcare resource utilization and costs wereassessed. Follow-up health care costs were adjusted to per-patient-per-month.The generalized linear model (GLM) was used to assess cost and utilization differences among the cohorts. RESULTS: A total of 4,796 patients were identified(Typical LAI cohort: N=1,941; Atypical LAI cohort: N=2,855). Typical LAI patientswere older (age 53.81 vs. 50.94 years, p<0.0001) and more likely to be black (34.47%vs. 28.27%, p<0.0001) than atypical LAI patients. After adjusting for baseline differences using GLM, more patients prescribed typical LAIs had all-cause emergencyroom [ER] visits (61.66% vs. 58.11%, p=0.024) and inpatient stays (63.11% vs. 59.00%, p=0.008) and psychiatric disorder-related ER visits (33.83% vs. 30.05%, p=0.011)than those prescribed atypical LAIs. However, typical LAI patients incurred lowerall-cause pharmacy (197vs.197 vs. 433, p<0.001), total (2,850vs.2,850 vs. 3,073, p=0.048) andpsychiatric disorder-related total costs (1,615vs.1,615 vs. 1,624, p=0.908) than atypical LAIpatients. CONCLUSIONS: Although patients who initiated typical LAIs had highhealthcare resource utilization, their economic burden was lower compared to thosewho initiated atypical LAIs.WOS:000354498502041Science Citation Index Expanded - Social Sciences Citation IndexQ1Meeting AbstractUluslararası işbirliği ile yapılan - EVETMayıs2015YÖK - 2014-1

    Education to Improve Long-Acting Injectable Antipsychotic Use

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    Purpose: Long-acting injectable (LAI) antipsychotics are underutilized as an evidence-based treatment for schizophrenia and schizoaffective disorder. The purpose of this quality improvement project was to determine if a web-based LAI education module changed advance practice prescribers’ knowledge, attitudes, and practice behaviors regarding LAI antipsychotics one month after receiving LAI education at a community-based mental health organization. Methods: This QI project was an observational pre- post-educational design. The 20-item Knowledge, Attitudes, and Practices (KAP) questionnaire was used to assess advanced practice providers’ knowledge retention, attitude changes, and practice modifications regarding LAI antipsychotics and prospective patient chart reviews were performed. Results: Participants (N = 17) included 14 nurse practitioners, two physician assistants, and one psychiatrist. Friedman tests and pairwise comparisons determined practices subsection KAP scores were statistically significantly different between pre- and posttest scores (p = .021). Total KAP, knowledge and attitudes subsection scores were determined by Friedman tests to be statistically insignificant (p \u3e .05). An exact sign test and descriptive statistics determined there was an increase in LAIs prescribed in eight participants post-education, whereas six participants decreased LAIs prescribed post-education and three participants saw no improvement. There was no statistically significant median increase in LAIs prescribed (Mdn = 0.00) from pre-education (Mdn = 18.00) to post-education (Mdn = 19.00, p = .791). Implications for Practice: LAI education can increase LAI use and additional organizations may benefit by utilizing the LAI educational module as a viable resource if their LAI use is closer to the national average where improvements can best be measured
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