M112. Clozapine Use in Early-Intervention Programs Across Canada
Notice bibliographique
Résumé
Background: Clozapine remains to this day the treatment of choice for people with schizophrenia who have failed to respond to 2 consecutive antipsychotic trials. It is estimated that approximately 20% of first-episode psychotic patients fail to respond adequately to 2 consecutive antipsychotic trials, thereby meeting criteria for a Clozapine trial. As much as 80% of the first-episode patients meeting criteria for a Clozapine trial who undergo such a trial could show a robust response. Methods: A survey on Clozapine use was conducted across 11 early intervention programs in Canada (total N = 1771). We used Fleiss’ method (a meta-analysis technique) to derive mean prevalence estimates and to compare rates across programs according to 6 program characteristics. Results: The weighted mean rates of Clozapine use across programs was 13.5% (95% CI: 7.1%, 19%). The rates varied from 4.4% to 30%; these variations in rates of Clozapine use across programs were highly significant (P < .0001). Rates of CLZ use were higher in programs that that use a systematic algorithm to assess treatment resistance (17.2%) vs those that do not (13.6%; P < .0001); that have hospital beds (17.3%) vs those that do not (9.5%; P < .0001); that have a follow-up ≥ 3 years (14.2%) vs those with a <3-year follow-up (6.8%; P < .0001). There were no differences in rates of Clozapine use according to: (1) the inclusion or not of teenagers; (2) the percentage of patients in the first year of treatment; (3) the upper limit in duration of prior treatment for inclusion in the program. However, there was highly significant heterogeneity within all these groups. Conclusion: This survey thus documented rates of CLZ use in these early intervention programs that are even higher than the rates generally observed in other settings including more chronic patients. It also documented very important variations in rates of Clozapine use across these programs. We identified at least 3 distinct program characteristics that could account for part of this heterogeneity. However, there was highly significant heterogeneity across groups of programs defined according to any of these characteristics; hence, other sources of variations in Clozapine have yet to be identified. Hence, data at an individual level are needed to better understand the determinants of Clozapine use. Such data could eventually lead to recommendations to guide optimal Clozapine use in early intervention programs; we are currently completing such an investigation based on individual chart reviews.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,007 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».