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| 13. |
- Kiessling, A, et al.
(författare)
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Quality of medical certificates issued in long-term sick leave or disability in relation to patient characteristics and delivery of health care
- 2013
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 41:4, s. 412-420
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To assess the quality of medical certificates issued during long-term sick leave or disability. Methods: We collected a stratified randomised sample of 250 medical certificates issued for assessment of work capacity: Certificates issued in primary health care (PHC) with a locomotor, psychiatric or other main diagnosis, in psychiatric care, and in other secondary care. Four experts performed a quality assessment per section of the certificate and globally. Results: The certificates varied from short notes to extensive documents. Those issued in PHC included more diagnoses per certificate ( p <0.0001) than in secondary care. PHC physicians had a longer professional relationship to their patients ( p = 0.009). Information on work capacity was entirely adequate and relevant in only 10% of the certificates. Disturbed mental function was indicated in 60% of the certificates without psychiatric main diagnosis. Whether indicated medical state influenced functional state was not assessable in 46 (19 %) of the certificates due to lack of information. Similarly, if reduced function influenced working capacity was not assessable in 66 (27 %) of the certificates. The global quality differed ( p <0.0001) between certificates issued in primary care 5.7 (CI 5.5–5.9) and secondary care 6.9 (CI 6.5–7.3). Conclusions: There is a need for improvement of the quality of medical certificates issued in cases of long-term sick leave or disability. The quality of medical certificates was low and lacked necessary information requested by the Social Insurance Agency. The quality was lower in certificates issued in primary care, which might be explained by a different case-mix.
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- Nikisch, G, et al.
(författare)
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Cytochrome P450 and ABCB1 genetics: association with quetiapine and norquetiapine plasma and cerebrospinal fluid concentrations and with clinical response in patients suffering from schizophrenia. A pilot study
- 2011
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Ingår i: Journal of psychopharmacology (Oxford, England). - : SAGE Publications. - 1461-7285 .- 0269-8811. ; 25:7, s. 896-907
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Tidskriftsartikel (refereegranskat)abstract
- Variability in response to atypical antipsychotic drugs is due to genetic and environmental factors. Cytochrome P450 (CYP) isoforms are implicated in the metabolism of drugs, while the P-glycoprotein transporter (P-gp), encoded by the ABCB1 gene, may influence both the blood and brain drug concentrations. This study aimed to identify the possible associations of CYP and ABCB1 genetic polymorphisms with quetiapine and norquetiapine plasma and cerebrospinal fluid (CSF) concentrations and with response to treatment. Twenty-two patients with schizophrenia receiving 600 mg of quetiapine daily were genotyped for four CYP isoforms and ABCB1 polymorphisms. Quetiapine and norquetiapine peak plasma and CSF concentrations were measured after 4 weeks of treatment. Stepwise multiple regression analysis revealed that ABCB1 3435C > T (rs1045642), 2677G > T (rs2032582) and 1236C > T (rs1128503) polymorphisms predicted plasma quetiapine concentrations, explaining 41% of the variability ( p = 0.001). Furthermore, the ABCB1 polymorphisms predicted 48% ( p = 0.024) of the variability of the Δ PANSS total score, with the non-carriers of the 3435TT showing higher changes in the score. These results suggest that ABCB1 genetic polymorphisms may be a predictive marker of quetiapine treatment in schizophrenia.
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