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Page 1 of 11

  • Point of care assay for blood aripiprazole concentrations: development, validation and utility

  • Matthew Atkins, David Taylor, Ana Catalan, Neville Desouza, Edward Chesney, Thomas J. Reilly, Irina Baburina, Mary Rose Hilaire, Luiz Dratcu, Robert Harland, Salvatore J. Salamone, Philip McGuire
  • Journal:
    The British Journal of Psychiatry / Volume 223 / Issue 2 / August 2023
    Published online by Cambridge University Press:
    31 May 2023, pp. 389-393
    Print publication:
    August 2023
  • Background

    The antipsychotic aripiprazole is often used in the treatment of first-episode psychosis. Measuring aripiprazole blood levels provides an objective measure of treatment adherence, but this currently involves taking a venous blood sample and sending to a laboratory for analysis.

    Aims

    To detail the development, validation and utility of a new point of care (POC) test for finger-stick capillary blood concentrations of aripiprazole.

    Method

    Analytical performance (sensitivity, precision, recovery and linearity) of the assay were established using spiked whole blood and control samples of varying aripiprazole concentration. Assay validation was performed over a 14-month period starting in July 2021. Eligible patients were asked to provide a finger-stick capillary sample in addition to their usual venous blood sample. Capillary blood samples were tested by the MyCare™ Insite POC analyser, which provided measurement of aripiprazole concentration in 6 min, and the venous blood sample was tested by the standard laboratory method.

    Results

    A total of 101 patients agreed to measurements by the two methods. Venous blood aripiprazole concentrations as assessed by the laboratory method ranged from 17 to 909 ng/mL, and from 1 to 791 ng/mL using POC testing. The correlation coefficient between the two methods (r) was 0.96 and there was minimal bias (slope 0.91, intercept 4 ng/ml).

    Conclusions

    The MyCare Insite POC analyser is sufficiently accurate and reliable for clinical use. The availability of this technology will improve the assessment of adherence to aripiprazole and the optimising of aripiprazole dosing.

  • Life Course Predictors of Young Men Surviving to Age 90 in a Cohort Study: The Manitoba Follow-up Study

  • Robert B. Tate, Audrey U. Swift, Edward H. Thompson, Jr., Philip D. St. John
  • Journal:
    Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 42 / Issue 1 / March 2023
    Published online by Cambridge University Press:
    06 July 2022, pp. 13-19
    Print publication:
    March 2023
    • Article
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  • The purpose of this study was to identify factors at various time points in life that are associated with surviving to age 90. Data from men enrolled in a cohort study since 1948 were considered in 12-year intervals. Logistic regression models were constructed with the outcome of surviving to age 90. Factors were: childhood illness, blood pressure (BP), body mass index (BMI), chronic diseases, and electrocardiogram (ECG) findings. After 1996, the Short Form-36 was added. A total of 3,976 men were born in 1928 or earlier, and hence by the end of our study window in 2018, each had the opportunity of surviving to age 90. Of these, 721 did live to beyond his 90th birthday.The factors in 1948 which predicted surviving were: lower diastolic BP, lower BMI, and not smoking. In 1960, these factors were: lower BP, lower BMI, not smoking, and no major ECG changes. In 1972, these factors were lower BP, not smoking, and fewer disease states. In 1984, these factors were lower systolic BP, not smoking, ECG changes, and fewer disease states. In 1996, the factors were fewer disease states and higher physical and mental health functioning. In 2008, only higher physical functioning predicted survival to the age of 90. In young adulthood, risk factors are important predictors of surviving to age 90; in mid-life, chronic illnesses emerge, and in later life, functional status becomes predominant.

  • A large outbreak of COVID-19 in a UK prison, October 2020 to April 2021

  • James P. Adamson, Christopher Smith, Nicole Pacchiarini, Thomas Richard Connor, Janet Wallsgrove, Ian Coles, Clare Frost, Angharad Edwards, Jaisi Sinha, Catherine Moore, Steph Perrett, Christie Craddock, Clare Sawyer, Alison Waldram, Alicia Barrasa, Daniel Rh. Thomas, Philip Daniels, Heather Lewis
  • Journal:
    Epidemiology & Infection / Volume 150 / 2022
    Published online by Cambridge University Press:
    30 May 2022, e134
    • Article
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  • Prisons are susceptible to outbreaks. Control measures focusing on isolation and cohorting negatively affect wellbeing. We present an outbreak of coronavirus disease 2019 (COVID-19) in a large male prison in Wales, UK, October 2020 to April 2021, and discuss control measures.

    We gathered case-information, including demographics, staff-residence postcode, resident cell number, work areas/dates, test results, staff interview dates/notes and resident prison-transfer dates. Epidemiological curves were mapped by prison location. Control measures included isolation (exclusion from work or cell-isolation), cohorting (new admissions and work-area groups), asymptomatic testing (case-finding), removal of communal dining and movement restrictions. Facemask use and enhanced hygiene were already in place. Whole-genome sequencing (WGS) and interviews determined the genetic relationship between cases plausibility of transmission.

    Of 453 cases, 53% (n = 242) were staff, most aged 25–34 years (11.5% females, 27.15% males) and symptomatic (64%). Crude attack-rate was higher in staff (29%, 95% CI 26–64%) than in residents (12%, 95% CI 9–15%).

    Whole-genome sequencing can help differentiate multiple introductions from person-to-person transmission in prisons. It should be introduced alongside asymptomatic testing as soon as possible to control prison outbreaks. Timely epidemiological investigation, including data visualisation, allowed dynamic risk assessment and proportionate control measures, minimising the reduction in resident welfare.

  • 7.3 - Sedation and Neuromuscular Blockade in Intensive Care

  • from Section 7 - Comfort and Recovery
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 660-662

  • Summary

    Key Learning Points

    1. 1. Goldilocks principle – always aim for just the right amount of sedation, comfort without coma.

    2. 2. Use of sedation holds/‘holidays’ can reduce the length of ventilator days.

    3. 3. Sedation protocols vary between institutions, but all rely on regular assessment of depth of sedation with standardised scoring systems.

    4. 4. Use of neuromuscular blockade in critical care has modest association with neuromuscular dysfunction seen in critical illness weakness.

    5. 5. Use of early neuromuscular blockade in moderate to severe acute respiratory distress syndrome has been shown to reduce mortality.

Thomas Adès Studies
  • Edited by Edward Venn, Philip Stoecker
  • Published online:
    18 November 2021
    Print publication:
    25 November 2021
  • Thomas Adès is a dominant force in contemporary music, whose work attracts significant attention and acclaim, and has been performed by many renowned ensembles. This volume – the first to present a range of scholarly essays on every aspect of Adès's music – offers authoritative accounts of Adès's major compositions from a variety of analytical, critical, cultural and historical perspectives. The opening chapters focus on Adès's earlier music, offering close readings of key works. Further essays focus on his engagement with forms and instrumental genres. The final chapters turn to Adès's texted music and highlight how themes introduced in earlier chapters cut across Adès's entire output. Richly illustrated with musical examples and supported by further online material, this book provides a multi-faceted portrait of Adès's work that opens up new ways of thinking about, and engaging with, his music.

  • Life expectancy, mortality risks and cause of death in patients with serious mental illness in South East London: a comparison between 2008–2012 and 2013–2017

  • Chi-Kang Chang, Edward Chesney, Wei-Nung Teng, Sam Hollandt, Megan Pritchard, Hitesh Shetty, Robert Stewart, Philip McGuire, Rashmi Patel
  • Journal:
    Psychological Medicine / Volume 53 / Issue 3 / February 2023
    Published online by Cambridge University Press:
    07 September 2021, pp. 887-896
    Print publication:
    February 2023
    • Article
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  • Background

    People with serious mental illness (SMI) have a significantly shorter life expectancy than the general population. This study investigates whether the mortality rate in this group has changed over the last decade.

    Methods

    Using Clinical Record Interactive Search software, we extracted data from a large electronic database of patients in South East London. All patients with schizophrenia, schizoaffective disorder or bipolar disorder from 2008 to 2012 and/or 2013 to 2017 were included. Estimates of life expectancy at birth, standardised mortality ratios and causes of death were obtained for each cohort according to diagnosis and gender. Comparisons were made between cohorts and with the general population using data obtained from the UK Office of National Statistics.

    Results

    In total, 26 005 patients were included. In men, life expectancy was greater in 2013–2017 (64.9 years; 95% CI 63.6–66.3) than in 2008–2012 (63.2 years; 95% CI 61.5–64.9). Similarly, in women, life expectancy was greater in 2013–2017 (69.1 years; 95% CI 67.5–70.7) than in 2008–2012 (68.1 years; 95% CI 66.2–69.9). The difference with general population life expectancy fell by 0.9 years between cohorts in men, and 0.5 years in women. In the 2013–2017 cohorts, cancer accounted for a similar proportion of deaths as cardiovascular disease.

    Conclusions

    Relative to the general population, life expectancy for people with SMI is still much worse, though it appears to be improving. The increased cancer-related mortality suggests that physical health monitoring should consider including cancer as well.

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