Katja Taxis - Academia.edu (original) (raw)
Papers by Katja Taxis
British Medical Journal, 2003
Objectives To determine the incidence and clinical importance of errors in the preparation and ad... more Objectives To determine the incidence and clinical importance of errors in the preparation and administration of intravenous drugs and the stages of the process in which errors occur. Design Prospective ethnographic study using disguised observation. Participants Nurses who prepared and administered intravenous drugs. Setting 10 wards in a teaching and non-teaching hospital in the United Kingdom. Main outcome measures Number, type, and clinical importance of errors. Results 249 errors were identified. At least one error occurred in 212 out of 430 intravenous drug doses (49%, 95% confidence interval 45% to 54%). Three doses (1%) had potentially severe errors, 126 (29%) potentially moderate errors, and 83 (19%) potentially minor errors. Most errors occurred when giving bolus doses or making up drugs that required multiple step preparation. Conclusions The rate of intravenous drug errors was high. Although most errors would cause only short term adverse effects, a few could have been serious. A combination of reducing the amount of preparation on the ward, training, and technology to administer slow bolus doses would probably have the greatest effect on error rates.
International Journal of Nursing Studies, 2011
Background: The medication cart can be filled using an automated system or a manual method and wh... more Background: The medication cart can be filled using an automated system or a manual method and when using a manual method the medication can be arranged either by round time or by medication name. For the manual methods, it is hypothesized that the latter method would result in a lower frequency of medication administration errors because nurses are forced to read the medication labels, but evidence for this hypothesis is lacking. Objectives: The aim of this study was to compare the frequency of medication administration errors of two different manual medication cart filling methods, namely arranging medication by round time or by medication name. Design: A prospective, observational study with a before-after design. Participants and settings: Eighty-six patients who stayed on an orthopaedic ward in one university medical centre in the Netherlands were included. Methods: Disguised observation was used to detect medication administration errors. The medication cart filling method in usual care was to fill the cart with medication arranged by round time. The intervention was the implementation of the second medication cart filling method, where the medication cart was filled by arranging medicines by their names. The primary outcome was the frequency of medication administrations with one or more error(s) after the intervention compared with before the intervention. The secondary outcome was the frequency of subtypes of medication administration errors. Results: After the intervention 170 of 740 (23.0%) medication administrations with one or more medication administration error(s) were observed compared to 114 of 589 (19.4%) before the intervention (odds ratio 1.24 [95% confidence interval 0.95-1.62]). The distribution of subtypes of medication administration errors before and after the intervention was statistically significantly different (p < 0.001). Analysis of subtypes revealed more omissions and wrong time errors after the intervention than before the intervention. Unauthorized medication errors were detected more frequently before the intervention than after the intervention.
Journal of Affective Disorders
Background: Depressive symptoms require accurate recognition and monitoring in clinical practice ... more Background: Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia. Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms. Objective: We reviewed depression instruments on their reliability and validity in patients with schizophrenia. Methodology: A systematic literature search was carried out in three electronic databases. Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications. Results: Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia. The only self-report was the Beck Depression Inventory (BDI). The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated. All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia. The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity). Conclusions: We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia. A valid selfreport instrument is to be developed for the use in clinical practice.
Schizophrenia Research, 2010
and thickness change was calculated using regression analyses covarying for age and sex. The stat... more and thickness change was calculated using regression analyses covarying for age and sex. The statistics were corrected for multiple comparisons (alpha=0.05; false discovery rate control). Regression analyses using a locally-weighted running-line smoother with different degrees of freedom were performed to obtain the best descriptions of the age-dependency of the brain measures. Results: Excessive decreases in gray matter volume in patients relative to controls were found. Excessive decreases in gray matter density and cortical thickness in patients relative to controls were found predominantly in the frontal and temporal cortices. Parietal and occipital lobes were relatively spared. Excessive density decreases and cortical thinning seemed more pronounced in the left hemisphere, particularly in the left frontal cortical areas. Moreover, patients show different trajectories of age-related brain volume and cortical thickness change. Discussion: The findings are in line with earlier longitudinal volumetric and voxel-based morphometry studies suggesting progressive changes in schizophrenia patients in particularly frontal and temporal areas in the brain. We found differences in age-related gray and white matter volume and cortical thickness change between patients with schizophrenia and comparison subjects which would be suggestive for abnormal maturation of the brain in adult schizophrenia.
Journal of Psychiatric Research, 2009
Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophr... more Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia.This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% (n = 92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up.
Schizophrenia Research, 2008
Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients.... more Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients. This study aimed to identify incidence of metabolic syndrome and its reversibility in one year follow-up. Methods: Between 01/2003 and 04/2007 all patients in the department of psychotic disorders of a mental health care centre in the Netherlands were asked to participate in a screening program. Patients who had two complete screenings in one year follow-up were included in this analysis. Prevalence of metabolic syndrome were calculated by dividing the number of patients with metabolic syndrome by the number of all patients. Incidence was calculated by dividing new cases of metabolic syndrome by patients at risk, i.e. all patients who did not have metabolic syndrome at first screening. Results: In total 260 patients were included: 62% (n=162) were male, 38% (n=98) female. Average age was 38 (SD=11.9) years and median duration of disease was nine years. Prevalence of metabolic syndrome (ATP III/NCEP criteria) was 35% (n=92) at first and 33% (n =86) at second screening. Incidence of metabolic syndrome in one year was 14% (n=24). Thirty patients (33%) had metabolic syndrome at the first screening, but not at second screening. Conclusions: This follow-up study showed a high prevalence of metabolic syndrome in schizophrenic patients at both consecutive screenings. Surprisingly, a substantial number of patients developed or lost the metabolic syndrome over the course of one year.
Schizophrenia Research, 2008
places, faith-healers, astrologers, complementary medical centers, etc. The number (%) of patient... more places, faith-healers, astrologers, complementary medical centers, etc. The number (%) of patients that sought help from magicoreligious and non-psychiatric medical centers were 19 (47.5%) and 16 (40%) respectively. The median number of months spent in magico-religious tr eatment was one month (min=1 week; max=12 months); it was one month (min=3 weeks; max=27 months) for non-psychiatric medical centers. Conclusions: Patients spend a substantial proportion of their DUP in seeking help from magicoreligious healing c enters and nonpsychiatrist doctors. Sensitizing these healers and doctors about early initiation of antipsychotic treatment could help to reduce DUP.
Journal of Clinical Psychopharmacology, 2009
Acta Psychiatrica Scandinavica, 2008
Objective: To investigate the feasibility of switching overweight schizophrenic patients to arip... more Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice.Method: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up.Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (≥3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean −3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean −4.4 kg).Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole.
Schizophrenia Research, 2008
Fortschritte Der Neurologie Psychiatrie, 2007
The effectiveness of pharmacotherapy partly depends on patients' compliance. However nonc... more The effectiveness of pharmacotherapy partly depends on patients' compliance. However noncompliance with pharmacotherapy occurs frequently. It is particularly a problem in diseases requiring long-term treatment. On average chronically ill patients only take about half of their medication as prescribed. Especially patients with chronic psychiatric diseases, such as schizophrenia, are known to have low compliance rates. Atypical antipsychotics or depot medication are believed to improve compliance. In our systematic literature review we identified ten studies analysing the differences in compliance rates between atypical and typical antipsychotics. However our analyses did not show a difference in compliance rates except for clozapine. The higher compliance rates for clozapine might be explained by the regular monitoring and thus frequent patient contact. A positive effect of depot antipsychotics on compliance could be explained by the easy detection of noncompliant patients.
Schizophrenia Research, 2008
Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients.... more Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients. This study aimed to identify incidence of metabolic syndrome and its reversibility in one year follow-up. Methods: Between 01/2003 and 04/2007 all patients in the department of psychotic disorders of a mental health care centre in the Netherlands were asked to participate in a screening program. Patients who had two complete screenings in one year follow-up were included in this analysis. Prevalence of metabolic syndrome were calculated by dividing the number of patients with metabolic syndrome by the number of all patients. Incidence was calculated by dividing new cases of metabolic syndrome by patients at risk, i.e. all patients who did not have metabolic syndrome at first screening. Results: In total 260 patients were included: 62% (n=162) were male, 38% (n=98) female. Average age was 38 (SD=11.9) years and median duration of disease was nine years. Prevalence of metabolic syndrome (ATP III/NCEP criteria) was 35% (n=92) at first and 33% (n =86) at second screening. Incidence of metabolic syndrome in one year was 14% (n=24). Thirty patients (33%) had metabolic syndrome at the first screening, but not at second screening. Conclusions: This follow-up study showed a high prevalence of metabolic syndrome in schizophrenic patients at both consecutive screenings. Surprisingly, a substantial number of patients developed or lost the metabolic syndrome over the course of one year.
European Journal of Clinical Pharmacology, 2004
Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) ... more Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) drugs, identify the stages in the process at which errors occurred and evaluate their clinical importance. Methods A prospective ethnographic study using disguised observation was carried out on two wards in one German non-university hospital. Results We observed 22 nurses administering 122 i.v. drug preparations and administrations. One or more errors occurred in the preparation and administration of 58 of 122 i.v. drug doses (error rate 48%, 95% confidence interval 39–57%). In total, 65 errors were identified. Of doses, 4 had potentially severe errors (3%), 38 (31%) potentially moderate errors and 16 (13%) potentially minor errors. Common errors included multiple step preparations and the co-administration of potentially incompatible drugs as intermittent infusions. Conclusion A high incidence of i.v. drug errors was found in the study hospital. Effective strategies to reduce potentially harmful errors are urgently needed. Measures could include a reduction in the number of ward-based i.v. drug preparations, improvement of staff training and the introduction of ward-based clinical pharmacy services.
Pharmacy World & Science, 2003
Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation ... more Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services. Method: A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP) and two hospitals in Germany, one with a traditional ward stock supply (TGP) and one with a satellite pharmacy service (GSP) with unit dose system. Main outcome measures: Errors in i.v. drug preparation and administration and their potential significance. Results: The number of observed preparations/administrations were: TBP 77/63, TGP 126/109 and GSP 134/106. The preparation error rates were: TBP 22% (95% confidence interval: 13‐31%), TGP 23% (16‐30%) and GSP 31% (23‐39%). The administration error rates were TBP 27% (16‐38%), TGP 49% (39‐58%) and GSP 22% (14‐30%). The percentage of administration errors on the wards with TGP was statistically significantly higher than in the other two services. Common errors at the study sites with TBP and GSP were omissions. Wrong rate of administration occurred most frequently on the wards with TGP. The majority of errors were likely to be of 'moderate' to 'severe' outcome. Careful drug chart reading could possibly reduce omission errors on the wards with TBP. A change of the German nursing law ('Krankenpflegegesetz') to legally entitle nurses to administer i.v. drugs could probably result in better training, national guidelines and standards. Conclusion: This study found a high rate of i.v. medication errors of moderate to severe significance. Changes in practice should be considered to make i.v. therapy safer for patients.
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Drug Safety, 2008
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Journal of Hospital Infection, 2004
Quality & Safety in Health Care, 2003
British Medical Journal, 2003
Objectives To determine the incidence and clinical importance of errors in the preparation and ad... more Objectives To determine the incidence and clinical importance of errors in the preparation and administration of intravenous drugs and the stages of the process in which errors occur. Design Prospective ethnographic study using disguised observation. Participants Nurses who prepared and administered intravenous drugs. Setting 10 wards in a teaching and non-teaching hospital in the United Kingdom. Main outcome measures Number, type, and clinical importance of errors. Results 249 errors were identified. At least one error occurred in 212 out of 430 intravenous drug doses (49%, 95% confidence interval 45% to 54%). Three doses (1%) had potentially severe errors, 126 (29%) potentially moderate errors, and 83 (19%) potentially minor errors. Most errors occurred when giving bolus doses or making up drugs that required multiple step preparation. Conclusions The rate of intravenous drug errors was high. Although most errors would cause only short term adverse effects, a few could have been serious. A combination of reducing the amount of preparation on the ward, training, and technology to administer slow bolus doses would probably have the greatest effect on error rates.
International Journal of Nursing Studies, 2011
Background: The medication cart can be filled using an automated system or a manual method and wh... more Background: The medication cart can be filled using an automated system or a manual method and when using a manual method the medication can be arranged either by round time or by medication name. For the manual methods, it is hypothesized that the latter method would result in a lower frequency of medication administration errors because nurses are forced to read the medication labels, but evidence for this hypothesis is lacking. Objectives: The aim of this study was to compare the frequency of medication administration errors of two different manual medication cart filling methods, namely arranging medication by round time or by medication name. Design: A prospective, observational study with a before-after design. Participants and settings: Eighty-six patients who stayed on an orthopaedic ward in one university medical centre in the Netherlands were included. Methods: Disguised observation was used to detect medication administration errors. The medication cart filling method in usual care was to fill the cart with medication arranged by round time. The intervention was the implementation of the second medication cart filling method, where the medication cart was filled by arranging medicines by their names. The primary outcome was the frequency of medication administrations with one or more error(s) after the intervention compared with before the intervention. The secondary outcome was the frequency of subtypes of medication administration errors. Results: After the intervention 170 of 740 (23.0%) medication administrations with one or more medication administration error(s) were observed compared to 114 of 589 (19.4%) before the intervention (odds ratio 1.24 [95% confidence interval 0.95-1.62]). The distribution of subtypes of medication administration errors before and after the intervention was statistically significantly different (p < 0.001). Analysis of subtypes revealed more omissions and wrong time errors after the intervention than before the intervention. Unauthorized medication errors were detected more frequently before the intervention than after the intervention.
Journal of Affective Disorders
Background: Depressive symptoms require accurate recognition and monitoring in clinical practice ... more Background: Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia. Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms. Objective: We reviewed depression instruments on their reliability and validity in patients with schizophrenia. Methodology: A systematic literature search was carried out in three electronic databases. Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications. Results: Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia. The only self-report was the Beck Depression Inventory (BDI). The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated. All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia. The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity). Conclusions: We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia. A valid selfreport instrument is to be developed for the use in clinical practice.
Schizophrenia Research, 2010
and thickness change was calculated using regression analyses covarying for age and sex. The stat... more and thickness change was calculated using regression analyses covarying for age and sex. The statistics were corrected for multiple comparisons (alpha=0.05; false discovery rate control). Regression analyses using a locally-weighted running-line smoother with different degrees of freedom were performed to obtain the best descriptions of the age-dependency of the brain measures. Results: Excessive decreases in gray matter volume in patients relative to controls were found. Excessive decreases in gray matter density and cortical thickness in patients relative to controls were found predominantly in the frontal and temporal cortices. Parietal and occipital lobes were relatively spared. Excessive density decreases and cortical thinning seemed more pronounced in the left hemisphere, particularly in the left frontal cortical areas. Moreover, patients show different trajectories of age-related brain volume and cortical thickness change. Discussion: The findings are in line with earlier longitudinal volumetric and voxel-based morphometry studies suggesting progressive changes in schizophrenia patients in particularly frontal and temporal areas in the brain. We found differences in age-related gray and white matter volume and cortical thickness change between patients with schizophrenia and comparison subjects which would be suggestive for abnormal maturation of the brain in adult schizophrenia.
Journal of Psychiatric Research, 2009
Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophr... more Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia.This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% (n = 92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up.
Schizophrenia Research, 2008
Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients.... more Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients. This study aimed to identify incidence of metabolic syndrome and its reversibility in one year follow-up. Methods: Between 01/2003 and 04/2007 all patients in the department of psychotic disorders of a mental health care centre in the Netherlands were asked to participate in a screening program. Patients who had two complete screenings in one year follow-up were included in this analysis. Prevalence of metabolic syndrome were calculated by dividing the number of patients with metabolic syndrome by the number of all patients. Incidence was calculated by dividing new cases of metabolic syndrome by patients at risk, i.e. all patients who did not have metabolic syndrome at first screening. Results: In total 260 patients were included: 62% (n=162) were male, 38% (n=98) female. Average age was 38 (SD=11.9) years and median duration of disease was nine years. Prevalence of metabolic syndrome (ATP III/NCEP criteria) was 35% (n=92) at first and 33% (n =86) at second screening. Incidence of metabolic syndrome in one year was 14% (n=24). Thirty patients (33%) had metabolic syndrome at the first screening, but not at second screening. Conclusions: This follow-up study showed a high prevalence of metabolic syndrome in schizophrenic patients at both consecutive screenings. Surprisingly, a substantial number of patients developed or lost the metabolic syndrome over the course of one year.
Schizophrenia Research, 2008
places, faith-healers, astrologers, complementary medical centers, etc. The number (%) of patient... more places, faith-healers, astrologers, complementary medical centers, etc. The number (%) of patients that sought help from magicoreligious and non-psychiatric medical centers were 19 (47.5%) and 16 (40%) respectively. The median number of months spent in magico-religious tr eatment was one month (min=1 week; max=12 months); it was one month (min=3 weeks; max=27 months) for non-psychiatric medical centers. Conclusions: Patients spend a substantial proportion of their DUP in seeking help from magicoreligious healing c enters and nonpsychiatrist doctors. Sensitizing these healers and doctors about early initiation of antipsychotic treatment could help to reduce DUP.
Journal of Clinical Psychopharmacology, 2009
Acta Psychiatrica Scandinavica, 2008
Objective: To investigate the feasibility of switching overweight schizophrenic patients to arip... more Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice.Method: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up.Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (≥3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean −3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean −4.4 kg).Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole.
Schizophrenia Research, 2008
Fortschritte Der Neurologie Psychiatrie, 2007
The effectiveness of pharmacotherapy partly depends on patients' compliance. However nonc... more The effectiveness of pharmacotherapy partly depends on patients' compliance. However noncompliance with pharmacotherapy occurs frequently. It is particularly a problem in diseases requiring long-term treatment. On average chronically ill patients only take about half of their medication as prescribed. Especially patients with chronic psychiatric diseases, such as schizophrenia, are known to have low compliance rates. Atypical antipsychotics or depot medication are believed to improve compliance. In our systematic literature review we identified ten studies analysing the differences in compliance rates between atypical and typical antipsychotics. However our analyses did not show a difference in compliance rates except for clozapine. The higher compliance rates for clozapine might be explained by the regular monitoring and thus frequent patient contact. A positive effect of depot antipsychotics on compliance could be explained by the easy detection of noncompliant patients.
Schizophrenia Research, 2008
Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients.... more Cross-sectional studies showed a high prevalence of metabolic syndrome in schizophrenic patients. This study aimed to identify incidence of metabolic syndrome and its reversibility in one year follow-up. Methods: Between 01/2003 and 04/2007 all patients in the department of psychotic disorders of a mental health care centre in the Netherlands were asked to participate in a screening program. Patients who had two complete screenings in one year follow-up were included in this analysis. Prevalence of metabolic syndrome were calculated by dividing the number of patients with metabolic syndrome by the number of all patients. Incidence was calculated by dividing new cases of metabolic syndrome by patients at risk, i.e. all patients who did not have metabolic syndrome at first screening. Results: In total 260 patients were included: 62% (n=162) were male, 38% (n=98) female. Average age was 38 (SD=11.9) years and median duration of disease was nine years. Prevalence of metabolic syndrome (ATP III/NCEP criteria) was 35% (n=92) at first and 33% (n =86) at second screening. Incidence of metabolic syndrome in one year was 14% (n=24). Thirty patients (33%) had metabolic syndrome at the first screening, but not at second screening. Conclusions: This follow-up study showed a high prevalence of metabolic syndrome in schizophrenic patients at both consecutive screenings. Surprisingly, a substantial number of patients developed or lost the metabolic syndrome over the course of one year.
European Journal of Clinical Pharmacology, 2004
Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) ... more Objective To determine the incidence of errors in preparing and administering intravenous (i.v.) drugs, identify the stages in the process at which errors occurred and evaluate their clinical importance. Methods A prospective ethnographic study using disguised observation was carried out on two wards in one German non-university hospital. Results We observed 22 nurses administering 122 i.v. drug preparations and administrations. One or more errors occurred in the preparation and administration of 58 of 122 i.v. drug doses (error rate 48%, 95% confidence interval 39–57%). In total, 65 errors were identified. Of doses, 4 had potentially severe errors (3%), 38 (31%) potentially moderate errors and 16 (13%) potentially minor errors. Common errors included multiple step preparations and the co-administration of potentially incompatible drugs as intermittent infusions. Conclusion A high incidence of i.v. drug errors was found in the study hospital. Effective strategies to reduce potentially harmful errors are urgently needed. Measures could include a reduction in the number of ward-based i.v. drug preparations, improvement of staff training and the introduction of ward-based clinical pharmacy services.
Pharmacy World & Science, 2003
Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation ... more Objectives: To investigate the incidence and the severity of intravenous (i.v.) drug preparation and administration errors in two countries and three pharmacy services. Method: A disguised observational method was used to record details of the preparation and administration of prescribed i.v. drugs on two wards in each of three teaching hospitals: one with a traditional British ward pharmacy service (TBP) and two hospitals in Germany, one with a traditional ward stock supply (TGP) and one with a satellite pharmacy service (GSP) with unit dose system. Main outcome measures: Errors in i.v. drug preparation and administration and their potential significance. Results: The number of observed preparations/administrations were: TBP 77/63, TGP 126/109 and GSP 134/106. The preparation error rates were: TBP 22% (95% confidence interval: 13‐31%), TGP 23% (16‐30%) and GSP 31% (23‐39%). The administration error rates were TBP 27% (16‐38%), TGP 49% (39‐58%) and GSP 22% (14‐30%). The percentage of administration errors on the wards with TGP was statistically significantly higher than in the other two services. Common errors at the study sites with TBP and GSP were omissions. Wrong rate of administration occurred most frequently on the wards with TGP. The majority of errors were likely to be of 'moderate' to 'severe' outcome. Careful drug chart reading could possibly reduce omission errors on the wards with TBP. A change of the German nursing law ('Krankenpflegegesetz') to legally entitle nurses to administer i.v. drugs could probably result in better training, national guidelines and standards. Conclusion: This study found a high rate of i.v. medication errors of moderate to severe significance. Changes in practice should be considered to make i.v. therapy safer for patients.
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Drug Safety, 2008
Safety improvements are sometimes based on the premise that introducing measures to combat minor ... more Safety improvements are sometimes based on the premise that introducing measures to combat minor or no-harm incidents proportionately reduces the incidence of major incidents involving harm. This is in line with the principle of the Heinrich ratio, which asserts that there is a relatively fixed ratio between the incidence of no-harm incidents, minor incidents and major incidents. This principle has been advocated as a means of targeting and evaluating new safety initiatives. Both thought experimentation and analysis of empirical data were used to examine the plausibility of this principle. A descriptive statistical analysis was carried out using triangle plots to display the relative frequencies of the occurrence of safety incidents classified as minor, moderate or severe. Thought experiments indicated that the principle of a fixed Heinrich ratio has a dubious logical foundation. Analysis of emergency department attendance and studies of medication errors demonstrated marked variation in the relative ratios of different outcomes. Triangle plots of UK road traffic accident data revealed a hitherto unrecognized systematic pattern of change that contradicts the principle of the Heinrich ratio. This study of the principle of a fixed Heinrich ratio invalidates it: introducing measures to reduce the incidence of minor incidents will not inevitably reduce the incidence of major incidents pro rata. Any safety policies based on the assumption that the Heinrich ratio is true need to be rethought.
Journal of Hospital Infection, 2004
Quality & Safety in Health Care, 2003