TY - JOUR A1 - Egberts, Karin A1 - Fekete, Stefanie A1 - Häge, Alexander A1 - Hiemke, Christoph A1 - Scherf-Clavel, Maike A1 - Taurines, Regina A1 - Unterecker, Stefan A1 - Gerlach, Manfred A1 - Romanos, Marcel T1 - Therapeutisches Drug Monitoring zur Optimierung der Psychopharmakotherapie von Kindern und Jugendlichen: Update und Leitfaden für die Praxis JF - Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie N2 - Trotz verbesserter Evidenzbasis bestehen in der kinder- und jugendpsychiatrischen Pharmakotherapie viele Unsicherheiten über die Wirkung und Verträglichkeit der häufig off-label oder in Kombinationstherapie verordneten Medikamente. Gerade auch vor dem Hintergrund der in vielen Fällen notwendigen mittel- bis langfristigen Einnahme sollen unerwünschte Arzneimittelwirkungen in dieser Altersstufe möglichst minimiert und eine auf die individuellen Charakteristika der Patientin oder des Patienten zugeschnittene, effektive Dosierung gefunden werden. Kinder und Jugendliche scheinen nicht nur besonders anfällig für bestimmte unerwünschte Arzneimittelwirkungen, sondern sind auch iatrogenen Risiken durch Dosierungs- oder Applikationsfehler ausgesetzt, die zu Unter- oder Überdosierungen führen können mit entsprechend negativen Auswirkungen auf den Therapieerfolg. Neben einer strengen Indikationsstellung sind daher eine präzise Dosisfindung sowie systematische Überwachung der Sicherheit der Psychopharmakotherapie unverzichtbar. In diesem Artikel wird Therapeutisches Drug Monitoring als hilfreiches klinisches Instrument vorgestellt und beschrieben, wie dessen richtige Anwendung sowohl die Wirksamkeit als auch die Sicherheit und Verträglichkeit einer Psychopharmakotherapie im Kindes- und Jugendalter zum unmittelbaren Nutzen für die Patientinnen und Patienten verbessern kann. N2 - Despite the improved evidence base, many uncertainties remain in child and adolescent psychiatric pharmacotherapy about the efficacy and tolerability of drugs, which are often prescribed off-label or in combination therapy in this age group. Because medium- to long-term use is unavoidable in many cases, clinicians should minimize adverse drug reactions as far as possible and tailor an effective dosage to the individual characteristics of the patient. Not only are children and adolescents particularly vulnerable to certain adverse drug effects, they are also exposed to iatrogenic risks from dosing or application errors, which can lead to under- or overdosing with correspondingly negative effects on the success of the therapy. In addition to determining a strict indication, it is therefore essential to establish precise dosage and systematic monitoring of the safety of the psychopharmacotherapy. This article introduces therapeutic drug monitoring as a useful clinical tool and describes how its correct application in practice can improve the efficacy as well as the safety and tolerability of psychotropic therapy in children and adolescents for the immediate benefit of patients. T2 - Therapeutic drug monitoring to optimize psychopharmacotherapy in children and adolescents - Update and guidelines for practice KW - Psychopharmakotherapie KW - unerwünschte Arzneimittelwirkungen KW - Pharmakovigilanz KW - Therapeutisches Drug Monitoring KW - Qualitätssicherung KW - psychopharmacotherapy KW - adverse drug reactions KW - pharmacovigilance KW - therapeutic drug monitoring KW - quality assurance Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262038 SN - 1422-4917 SN - 1664-2880 VL - 50 IS - 2 ER - TY - JOUR A1 - Wegener, Sonja A1 - Schindhelm, Robert A1 - Sauer, Otto A. T1 - Implementing corrections of isocentric shifts for the stereotactic irradiation of cerebral targets: Clinical validation JF - Journal of Applied Clinical Medical Physics N2 - Purpose: Any Linac will show geometric imprecisions, including non-ideal alignment of the gantry, collimator and couch axes, and gantry sag or wobble. Their angular dependence can be quantified and resulting changes of the dose distribution predicted (Wack, JACMP 20(5), 2020). We analyzed whether it is feasible to correct geometric shifts during treatment planning. The successful implementation of such a correction procedure was verified by measurements of different stereotactic treatment plans. Methods: Isocentric shifts were quantified for two Elekta Synergy Agility Linacs using the QualiForMed ISO-CBCT+ module, yielding the shift between kV and MV isocenters, the gantry flex and wobble as well as the positions of couch and collimator rotation axes. Next, the position of each field's isocenter in the Pinnacle treatment planning system was adjusted accordingly using a script. Fifteen stereotactic treatment plans of cerebral metastases (0.34 to 26.53 cm3) comprising 9–11 beams were investigated; 54 gantry and couch combinations in total. Unmodified plans and corrected plans were measured using the Sun Nuclear SRS-MapCHECK with the Stereophan phantom and evaluated using gamma analysis. Results: Geometric imprecisions, such as shifts of up to 0.8 mm between kV and MV isocenter, a couch rotation axis 0.9 mm off the kV isocente,r and gantry flex with an amplitude of 1.1 mm, were found. For eight, mostly small PTVs D98 values declined more than 5% by simulating these shifts. The average gamma (2%/2 mm, absolute, global, 20% threshold) was reduced from 0.53 to 0.31 (0.32 to 0.30) for Linac 1 (Linac 2) when including the isocentric corrections. Thus, Linac 1 reached the accuracy level of Linac 2 after correction. Conclusion: Correcting for Linac geometric deviations during the planning process is feasible and was dosimetrically validated. The dosimetric impact of the geometric imperfections can vary between Linacs and should be assessed and corrected where necessary. KW - isocenter KW - quality assurance KW - stereotactic irradiation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312906 VL - 23 IS - 5 ER - TY - JOUR A1 - Vloet, Timo D. A1 - Feteke, Stefanie A1 - Gerlach, Manfred A1 - Romanos, Marcel T1 - Das pharmakologische Management kinder- und jugendpsychiatrischer Notfälle : Evidenz und Qualitätssicherung JF - Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie N2 - Kinder- und jugendpsychiatrische Notfälle sind häufig und stellen die beteiligten Ärztinnen und Ärzte vor besondere Herausforderungen, da eine erhebliche Gefahr für die Patient_innen oder Dritte unter Anwendung möglichst wenig invasiver Mittel abzuwenden ist. In diesem Kontext werden neben haltgebenden, deeskalierenden und psychotherapeutischen Optionen häufig auch pharmakologische Interventionen eingesetzt. Da ein Mangel an systematisch erhobenen Daten besteht, findet die pharmakologische Notfallbehandlung in der Kinder- und Jugendpsychiatrie regelhaft im off-label-Bereich statt. Vor dem Hintergrund der komplexen klinischen und rechtlichen Anforderungen an die Ärztinnen und Ärzte werden im vorliegenden Artikel praxisrelevante Hinweise insbesondere zum pharmakologischen Management von in der Praxis häufig auftretenden kinder- und jugendpsychiatrischen Notfällen wie akuter Suizidalität, akut psychotischem Erleben, Delir und Bewusstseinsstörungen sowie akuter Intoxikation und Alkoholentzugssyndrom gegeben. Weiterhin werden Maßnahmen zur Qualitätssicherung und Arzneimittelsicherheit diskutiert. N2 - Emergencies in child and adolescent psychiatry are highly prevalent and often pose significant challenges to physicians, since substantial danger to the patient or others must be avoided through the application of largely moderate interventions. Besides using de-escalating strategies and exploiting psychotherapeutic options, the physician frequently employs psychopharmacological interventions. because of a lack of systematically assessed data, however, in emergencies in child and adolescent psychiatry most administrations of psychotropic drugs occur “off label.“ This review deduces practice-relevant recommendations for the pharmacological management of occurring child and adolescent emergencies such as acute suicidality, acute psychotic episodes, delirium, disorders of consciousness, acute intoxication, and alcohol withdrawal syndrome. We discuss the issue of quality and safety in pharmacological emergency strategies. T2 - The pharmacological management of emergencies in child and adolescent psychiatry KW - Psychiatrischer Notfall KW - Qualitätssicherung KW - Pharmakotherapie KW - Kinder und Jugendliche KW - TDM KW - psychiatric emergencies KW - quality assurance KW - pharmacotherapy KW - child and adolescent KW - TDM Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-280982 SN - 1422-4917 SN - 1664-2880 VL - 50 IS - 4 SP - 262-274 ER - TY - JOUR A1 - Dietzsch, Stefan A1 - Braesigk, Annett A1 - Seidel, Clemens A1 - Remmele, Julia A1 - Kitzing, Ralf A1 - Schlender, Tina A1 - Mynarek, Martin A1 - Geismar, Dirk A1 - Jablonska, Karolina A1 - Schwarz, Rudolf A1 - Pazos, Montserrat A1 - Weber, Damien C. A1 - Frick, Silke A1 - Gurtner, Kristin A1 - Matuschek, Christiane A1 - Harrabi, Semi Ben A1 - Glück, Albrecht A1 - Lewitzki, Victor A1 - Dieckmann, Karin A1 - Benesch, Martin A1 - Gerber, Nicolas U. A1 - Obrecht, Denise A1 - Rutkowski, Stefan A1 - Timmermann, Beate A1 - Kortmann, Rolf-Dieter T1 - Types of deviation and review criteria in pretreatment central quality control of tumor bed boost in medulloblastoma—an analysis of the German Radiotherapy Quality Control Panel in the SIOP PNET5 MB trial JF - Strahlentherapie und Onkologie N2 - Purpose In Germany, Austria, and Switzerland, pretreatment radiotherapy quality control (RT-QC) for tumor bed boost (TB) in non-metastatic medulloblastoma (MB) was not mandatory but was recommended for patients enrolled in the SIOP PNET5 MB trial between 2014 and 2018. This individual case review (ICR) analysis aimed to evaluate types of deviations in the initial plan proposals and develop uniform review criteria for TB boost. Patients and methods A total of 78 patients were registered in this trial, of whom a subgroup of 65 patients were available for evaluation of the TB treatment plans. Dose uniformity was evaluated according to the definitions of the protocol. Additional RT-QC criteria for standardized review of target contours were elaborated and data evaluated accordingly. Results Of 65 initial TB plan proposals, 27 (41.5%) revealed deviations of target volume delineation. Deviations according to the dose uniformity criteria were present in 14 (21.5%) TB plans. In 25 (38.5%) cases a modification of the RT plan was recommended. Rejection of the TB plans was rather related to unacceptable target volume delineation than to insufficient dose uniformity. Conclusion In this analysis of pretreatment RT-QC, protocol deviations were present in a high proportion of initial TB plan proposals. These findings emphasize the importance of pretreatment RT-QC in clinical trials for MB. Based on these data, a proposal for RT-QC criteria for tumor bed boost in non-metastatic MB was developed. KW - brain tumor KW - pediatric KW - focal radiotherapy KW - quality assurance KW - individual case review Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-307812 SN - 0179-7158 SN - 1439-099X VL - 198 IS - 3 ER -