Description de l’utilisation et de la pertinence de la clozapinémie pour une patientèle adulte et pédiatrique de deux centres hospitaliers universitaires de Québec
Bibliographic record
Abstract
Resume Objectifs : Decrire l’utilisation et la pertinence du monitorage therapeutique de la clozapine pour une patientele hospitalisee adulte et pediatrique selon le contexte du dosage, de la conformite de la procedure et de l’effet clinique. Le second objectif traite des caracteristiques des groupes divises selon le ratio de clozapine/norclozapine. Methode : Serie consecutive de patients entre janvier 2006 et decembre 2015 ayant eu une clozapinemie lors d’une hospitalisation au CHUL du CHU de Quebec - Universite Laval ou au Centre de pedopsychiatrie de Quebec (patientele en sante mentale du Centre integre universitaire de sante et de services sociaux Capitale-Nationale). Les donnees portaient sur : l’indication du dosage, les criteres de conformite, le delai d’attente du resultat et les interventions de l’equipe. L’objectif secondaire necessitait une collecte des donnees concernant les ratios de clozapine/norclozapine, le poids et la taille, le taux de readmissions pendant l’annee suivante ainsi que la medication concomitante. Resultats : Parmi 75 hospitalisations de patients qui prenaient de la clozapine, 46 (61,3 %) rapportaient un prelevement plasmatique et 102 clozapinemies ont ete effectuees au total. Dans la majorite des cas, les investigateurs ont note le respect de la procedure en vigueur (81,4 % pour le delai de 12 heures entre la derniere dose et le prelevement; 77,5 % pour l’atteinte d’un etat d’equilibre). Une majorite des modifications de dose survenaient apres l’obtention du resultat (59,1 % des interventions contre 40,9 %; p = 0,038). Quand les ratios de clozapine/norclozapine etaient eleves (≥ 2,0), les patients avaient tendance a avoir un poids plus faible (- 9,3 kg; p = 0,096), mais le taux de readmission etait similaire pour tous a un an (41,7 % versus 41,2 %). Conclusions : Le monitorage therapeutique est un outil pertinent et couramment utilise par l’equipe traitante, dans un cadre conforme aux procedures. Le ratio de clozapine/norclozapine demeure une avenue therapeutique a explorer. Abstract Objectives: To describe the use and relevance of clozapine therapeutic monitoring in adult and pediatric inpatients according to the context of the assay, procedural compliance and clinical impact. The secondary objective concerned the characteristics of the groups defined according to the clozapine/norclozapine ratio. Methodology: A consecutive series of patients between January 2006 and December 2015 whose blood clozapine level was measured during a stay at the CHUL du CHU de Quebec-Universite Laval or the Centre de pedopsychiatrie. The data included the indication for the assay, the compliance criteria, the time to results, and the team’s interventions. For the secondary objective, the clozapine/norclozapine ratios, weight and height, the following-year readmission rate, and concomitant medications were collected. Results: Of 75 hospitalizations involving the use of clozapine, 46 (61.3%) reported at least one specimen collection, for a total of 102 blood clozapine values. Most were in accordance with the current procedure (81.4% with a time to results of 12 hours; 77.5% with steady-state levels reached). Most of the dose modifications were made after the result was obtained (59.1% of the interventions versus 40.9%; p = 0.038). For high clozapine/norclozapine ratios (≥ 2.0), patients tended to have a lower weight (- 9.3 kg; p = 0.096) but a similar 1-year readmission rate (41.7% versus 41.2%). Conclusions: Therapeutic monitoring is a relevant tool frequently used by the care team as per procedure. The clozapine/norclozapine ratio is a therapeutic approach worth exploring.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".