Background: It is commonly recommended that a switch to clozapine be implemented in the face of tardive dyskinesia, even if current treatment involves another “atypical” agent. However, reports do indicate clozapine carries a liability for tardive dyskinesia. Aims: This review sought to evaluate clozapine in relation to tardive dyskinesia in the context of available evidence. Methods: Medline, Embase, and PsycINFO databases were searched for studies published in English, using the keywords: clozapine AND tardive dyskinesia OR TD. References from major review articles were searched for additional relevant publications. Studies were included if they investigated: tardive dyskinesia in clozapine-treated patients diagnosed with schizophrenia spectrum disorders, and reported on two or more assessments of tardive dyskinesia severity measured by the Abnormal Involuntary Movement Scale; or clozapine’s tardive dyskinesia liability. Results: In total, 513 unique citations were identified and 29 reports met the inclusion criteria. Thirteen studies suggest clozapine reduces dyskinetic symptoms over time ( n=905 clozapine-treated participants); however, the minimum required dose and effect of withdrawal requires further investigation. The majority of reports which address clozapine’s liability for tardive dyskinesia are case studies (11 of 14 reports, 79%), and clozapine was only the first-line treatment in one of the remaining three studies reporting treatment-emergent dyskinetic symptoms with clozapine in 12% of patients. No significant between-drug differences were identified comparing clozapine’s risk to other atypical antipsychotics. Conclusions: Research to date supports switching to clozapine for the purpose of reducing tardive dyskinesia risk and/or treating existing tardive dyskinesia, but prospective randomized controlled trials are necessary if we are to substantiate existing recommendations.
Introduction Faculty development is often deployed by central medical schools, with little guidance from end-users. How and what faculty members can use to improve their performance requires a deeper understanding from this user group. This study aims to explore how faculty perceive learners’ feedback about their performance as educators. Methods This study is an explanatory mixed-method research, wherein community- and academic-based emergency medicine faculty members from nine regional hospitals were surveyed about their perceptions of various outcome measures for faculty development. Selected participants were invited to follow-up interviews. We analyzed the physicians’ perceptions toward teaching and performance feedback data based on faculty’s gender, role as academic or community physician, and work experience. Results The quantitative phase has 104 participants, and 15 of these were followed up with interviews. The gender of faculty does not have statistical or practical differences regarding their perceptions of learner feedback. Type of practice contains meaningful insights about the perception of learner feedback although it does not have a statistical difference. Moreover, an inverse trend exists between the physicians’ years of experience and their perceived value of learner feedback. Kruskal-Wallis test showed a significant difference in the faculty’s experience level and their perceived value for the metric “quantity of feedback commentary compared to their peer group” (H(4) = 12.21, p = 0.02), specifically between junior and senior faculty (p = 0.007). Some faculty stated that experienced faculty may perceive they have a very well-established style. Conclusions Diversifying feedback sources and delivery may be useful for different groups of faculty members. Junior physicians are more interested in gaining feedback about the quantity of their written feedback to students compared to more senior physicians. Learner feedback holds promise to trigger continuous improvement in community sites for those who fall behind compared to the academic sites.
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