Community-Based Service Use After Clozapine Treatment: A Mirror-Image Analysis of Public Claims Data.

Although clozapine demonstrates unique efficacy for treatment-resistant schizophrenia, its impact on community-based services remains largely underexplored. The authors examined changes in use of community-based services after clozapine treatment among a sample of 163 patients with schizophrenia by using public claims data in Allegheny County, Pennsylvania. Mirror-image analyses of service utilization were used to compare the 180-day period before treatment initiation with the 180-day period that began after 6 months of adherent treatment, accounting for age, race, and gender. Across demographic variables, clozapine treatment was associated with increased use of community-based services and decreased use of psychiatric inpatient services (p<0.05, Bonferroni corrected), suggesting that clozapine treatment shifts service needs from emergency care to community-based care and recovery.

Compliance in using a pneumatic compression device after total knee arthroplasty.

A prospective study was performed to assess compliance with using a pneumatic foot compression device for venous thrombosis prophylaxis after total knee arthroplasty. One hundred patients received the PlexiPulse pneumatic compression device after unilateral total knee arthroplasty. Patients were observed postoperatively by the nurses on their floor and by 2 impartial research assistants. Total time the patient spent wearing the device (as observed) was termed total compliance. Actual compliance was calculated by subtracting unusable time from total compliance. A survey was also issued to both patients and nurses to evaluate the device regarding comfort, ease of use, and effectiveness. Overall, actual patient compliance was 90.1%. Patients responded favorably to the device in terms of comfort and ease of application and removal. Nurses rated the PlexiPulse device highly when asked to compare it with other pneumatic compression devices they had used before.

Effect of pneumatic compression on fibrinolysis after total hip arthroplasty.

The purpose of this prospective randomized clinical study was to investigate the enhanced systemic fibrinolysis mechanism of venous thrombosis prevention by pneumatic compression after total hip arthroplasty. Fifty patients were randomized into one of two groups (one with pneumatic compression [n=25] and one without [n=25]). Blood was drawn from a radial arterial line immediately preoperatively (baseline), at skin closure, and 8 hours and 22 hours after the baseline sample. Serum determinations of antigen of tissue plasminogen activator and plasminogen activator inhibitor-1 were done using enzyme-linked immunosorbent assays. These data do not support the enhancement of systemic fibrinolysis mechanism for lowering thromboembolic risk after total hip arthroplasty by pneumatic compression devices. The results of this study showed no differences that were statistically significant between the two groups. The greatest difference was observed 8 hours after surgery for the plasminogen activator inhibitor-1 marker, (28.12 with compression versus 22.07 ng/mL without); however, this result was not statistically significant. The beneficial effect of mechanical compression is more likely achieved through increased flow, local fibrinolytic effects, or both.