1
|
Siddiqui ST, La Manna A, Connors E, Smith R, Vance K, Budesa Z, Goulka J, Beletsky L, Wood CA, Marotta P, Winograd RP. An evaluation of first responders' intention to refer to post-overdose services following SHIELD training. Harm Reduct J 2024; 21:39. [PMID: 38351046 PMCID: PMC10863209 DOI: 10.1186/s12954-024-00957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND First responders [law enforcement officers (LEO) and Fire/Emergency Medical Services (EMS)] can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of occupational safety and harm reduction training on first responders' intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination services, and whether those intentions differed by first responder profession. METHODS First responders in Missouri were trained using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model. Trainees' intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1-5 scale). A mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. RESULTS Between December 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with higher first responders' intentions to refer, with ITR to naloxone distribution (1.83-3.88) and syringe exchange (1.73-3.69) demonstrating the greatest changes, and drug treatment (2.94-3.95) having the least change. There was a significant increase in ITR score from pre- to post-test (β = 2.15; 95% CI 1.99, 2.30), and LEO-relative to Fire/EMS-had a higher score at pre-test (0.509; 95% CI 0.367, 0.651) but a lower score at post-test (0.148; 95% CI - 0.004, 0.300). CONCLUSION Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders' intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess the extent to which ITR translates to referral behavior in the field.
Collapse
Affiliation(s)
- Saad T Siddiqui
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA.
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Elizabeth Connors
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Zach Budesa
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Jeremiah Goulka
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Leo Beletsky
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Phillip Marotta
- Department of Social Work, Brown School, Washington University in St. Louis, St. Louis, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| |
Collapse
|
2
|
Winograd R, Budesa Z, Banks D, Carpenter R, Wood CA, Duello A, Thater P, Smith C. Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention. Subst Abus 2023; 44:184-195. [PMID: 37702074 PMCID: PMC10591854 DOI: 10.1177/08897077231186213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State's publicly-funded substance use specialty treatment system through a "Medication First" approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri's overdose crisis, examines whether improvements were experienced equally among Black and White clients. METHODS This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions. RESULTS White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients. CONCLUSION In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.
Collapse
Affiliation(s)
- Rachel Winograd
- University of Missouri – St. Louis, Missouri Institute of Mental Health
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Zach Budesa
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Devin Banks
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Ryan Carpenter
- University of Missouri – St. Louis, Department of Psychological Sciences
| | - Claire A. Wood
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Alex Duello
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Paul Thater
- University of Missouri – St. Louis, Missouri Institute of Mental Health
| | - Christine Smith
- Missouri Department of Mental Health, Division of Behavioral Health
| |
Collapse
|
3
|
Winograd RP, Coffey B, Woolfolk C, Wood CA, Ilavarasan V, Liss D, Jain S, Stringfellow E. To Prescribe or Not to Prescribe?: Barriers and Motivators for Progressing Along Each Stage of the Buprenorphine Training and Prescribing Path. J Behav Health Serv Res 2023; 50:165-180. [PMID: 35060002 DOI: 10.1007/s11414-021-09783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to identify the strongest barriers and motivators associated with each step toward buprenorphine prescribing (1. obtaining a waiver, 2. beginning to prescribe, and 3. prescribing to more people) among a sample of Missouri-based medical professionals (N = 130). Item weights (number of endorsements times mean rank of the item's importance) were calculated based on their responses. Across groups, lack of access to psychosocial support services, need for higher levels of care, and clinical complexity were strong barriers. Among non-prescribers (n = 57, 46.3%), administrative burden, potential of becoming an addiction clinic, and concern about misuse and diversion were most heavily weighted. Among prescribers (n = 66, 53.7%), patients' inability to afford medications was a barrier across phases. Prominent motivators among all groups were the effectiveness of buprenorphine, improvement in other health outcomes, and a personal interest in treating addiction. Only prescribers reported the presence of institutional support and mentors as significant motivators.
Collapse
Affiliation(s)
- Rachel P Winograd
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA.
| | - Bridget Coffey
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Candice Woolfolk
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Claire A Wood
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Vinith Ilavarasan
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - David Liss
- Department of Emergency Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Subodh Jain
- Spectrum Health, Division of Psychiatry and Behavioral Medicine, 2750 E Beltline NE, Grand Rapids, MI, 49525, USA
| | - Erin Stringfellow
- Massachusetts General Hospital Institute for Technology Assessment & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Koegler E, Wood CA, Johnson SD, Bahlinger L. Service providers' perspectives on substance use and treatment needs among human trafficking survivors. J Subst Abuse Treat 2022; 143:108897. [PMID: 36215910 DOI: 10.1016/j.jsat.2022.108897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Understanding substance use and treatment needs for survivors of human trafficking remains an underdeveloped area in the field of substance use treatment. This study assessed the nature of substance use among survivors of all types of human trafficking and identified treatment barriers and needs, as reported by human trafficking service providers in one Midwest major metropolitan area. METHODS Participants were purposively selected from agencies that served foreign-born and domestic-born survivors of human trafficking. The study interviewed fifteen key informants across 13 agencies directly serving survivors of trafficking. RESULTS Providers highlighted frequent use of alcohol and marijuana, as well as polysubstance use. They noted survivors' significant use of opioids, associated concerns regarding fentanyl-related deaths, and increased frequency of stimulant use. Barriers for addressing substance use problems with survivors included low self-perceptions of need, lack of available residential or inpatient treatment options, and prioritizing basic needs such as housing over substance use treatment. CONCLUSIONS Results underscore how broader trends in substance use and overdose in a region can mirror substance use patterns and treatment needs of human trafficking survivors. Further, a need exists for broader substance use screening and low-barrier referral services to address emergent needs of survivors of trafficking.
Collapse
Affiliation(s)
- Erica Koegler
- University of Missouri-St. Louis, 1 University Blvd., St. Louis, MO 63121, United States of America.
| | - Claire A Wood
- Missouri Institute of Mental Health, 1 University Blvd., St. Louis, MO 63121, United States of America.
| | - Sharon D Johnson
- University of Missouri-St. Louis, 1 University Blvd., St. Louis, MO 63121, United States of America.
| | - Lilly Bahlinger
- University of Missouri-St. Louis, 1 University Blvd., St. Louis, MO 63121, United States of America.
| |
Collapse
|
5
|
Wood CA, Duello A, Miles J, Lohmann B, Gochez-Kerr T, Richardson K, Anderson-Harper R, Winograd RP. Acceptance of medications for opioid use disorder in recovery housing programs in Missouri. J Subst Abuse Treat 2022; 138:108747. [DOI: 10.1016/j.jsat.2022.108747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/05/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023]
|
6
|
Del Pozo B, Sightes E, Goulka J, Ray B, Wood CA, Siddiqui S, Beletsky LA. Police discretion in encounters with people who use drugs: operationalizing the theory of planned behavior. Harm Reduct J 2021; 18:132. [PMID: 34915910 PMCID: PMC8675297 DOI: 10.1186/s12954-021-00583-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges.
Methods On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. Findings Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others’ approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach’s alpha of 0.81. Conclusion The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.
Collapse
Affiliation(s)
- Brandon Del Pozo
- The Miriam Hospital/Warren Alpert Medical School of Brown University, 164 Summit Avenue, Providence, RI, 02906, USA.
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Jeremiah Goulka
- Health in Justice Action Lab, Northeastern University, Boston, USA
| | - Brad Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Saad Siddiqui
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Leo A Beletsky
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, USA
| |
Collapse
|
7
|
Wood CA, Green L, La Manna A, Phillips S, Werner KB, Winograd RP, Stuckenschneider A. Balancing need and risk, supply and demand: Developing a tool to prioritize naloxone distribution. Subst Abus 2021; 42:974-982. [PMID: 33759727 DOI: 10.1080/08897077.2021.1901174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Opioid overdose deaths continue to rise nationally. The demand for naloxone, the opioid overdose antidote, is outpacing the supply. With increasing naloxone requests, tools to prioritize distribution are critical to ensure available supplies will reach those at highest risk of overdose. Methods: We developed a standardized "Naloxone Request Form" (NRF) and corresponding weighted prioritization algorithm to serve as decisional aid to better enable grant staff to prioritize naloxone distribution in a data-driven manner. The algorithm computed raw priority scores for each agency, which were then separated into the predetermined quintiles. Historical naloxone distribution decisions were compared with agencies' prioritization quintile. Results: Results demonstrated that the NRF and corresponding algorithm was successful at prioritizing agencies based on potential impact. Although, overall, naloxone was distributed more heavily to the agencies deemed highest priority, our algorithm identified significant shortcomings of the "first come, first served" method of distribution we had initially deployed. Conclusions: This work has laid the foundation to use this tool prospectively to allow for data-driven decision-making for naloxone distribution. Our tool is flexible and can be customized to best fit the needs of a variety of programs and locations to ensure the distribution of limited supplies of naloxone have the greatest impact.
Collapse
Affiliation(s)
- Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri-St. Louis, St Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St Louis, MO, USA
| | - Angie Stuckenschneider
- Division of Behavioral Health, Missouri Department of Mental Health, Jefferson City, MO, USA
| |
Collapse
|
8
|
Snape C, Triteos N, Wood CA, Robert G, Jones J. 134 A Quality Improvement Project—Physiotherapy Caseload Management on the Older Person’s Unit. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Complex health issues, co-morbidities and the number of patients living with frailty are critical concerns associated with the ageing population (Kojima et al, 2019). In this wider context, there is an emphasis on targeting resources efficaciously within the NHS. A consequence of capacity constraints, inpatient physiotherapy teams across the OPU at a large urban teaching hospital, prioritise their patient caseload, but lack evidence-based guidance on dosage and frequency of physiotherapy intervention, to inform the process. The aim of the quality improvement project was to design and deliver a staff education and training package to facilitate implementation of a newly-developed, evidence-based prioritisation resource.
Method
Plan-Do-Study-Act cycles and the Com-B model to influence behaviour changes were employed between October 2019 and March 2020. Stakeholders were engaged throughout the design process. Training to all 11 physiotherapists consisted of familiarisation with the resource through content discussion and “mock-use” training sessions to ensure intra/inter-rater-reliabilty. Physiotherapist staff knowledge and confidence of prioritisation was evaluated by questionnaire. Accuracy of use of the prioritisation tool was determined by comparison of staff prioritisation decision with expert opinion.
Results
From the 11 questionnaire responses, pre to post intervention physiotherapy knowledge of the prioritisation categories increased (43% to 100%), physiotherapist rated confidence using the prioritisation tool increased (mean score, 6.9 to 8.2/10) and accuracy of prioritisation of patients improved (mean 42.1% to 92.3%).
Conclusion
The education and training package developed to support implementation of the prioritisation tool resulted in improved staff knowledge and confidence of patient prioritisation and increased the accuracy of OPU physiotherapy targeting. This project has highlighted the importance of staff training in resource allocation to ensure that decisions regarding which patients receive physiotherapy intervention are efficacious. This has increased relevance in a department with a large number of rotational staff.
Collapse
Affiliation(s)
- C Snape
- Guy's and St Thomas' NHS foundation Trust; Guy's and St Thomas' NHS foundation Trust; King's College London University; Guy's and St Thomas' NHS foundation Trust
| | - N Triteos
- Guy's and St Thomas' NHS foundation Trust; Guy's and St Thomas' NHS foundation Trust; King's College London University; Guy's and St Thomas' NHS foundation Trust
| | - C A Wood
- Guy's and St Thomas' NHS foundation Trust; Guy's and St Thomas' NHS foundation Trust; King's College London University; Guy's and St Thomas' NHS foundation Trust
| | - G Robert
- Guy's and St Thomas' NHS foundation Trust; Guy's and St Thomas' NHS foundation Trust; King's College London University; Guy's and St Thomas' NHS foundation Trust
| | - J Jones
- Guy's and St Thomas' NHS foundation Trust; Guy's and St Thomas' NHS foundation Trust; King's College London University; Guy's and St Thomas' NHS foundation Trust
| |
Collapse
|
9
|
Ritchie S, Snape C, Triteos N, Vamadevan R, Olesk L, Wood CA, Jones GD, Jones J. 132 Physical Function Comparison of Acutely Unwell COVID-Negative Older Adults Pre-Pandemic and Through-Pandemic; “Covid-Protected”. Age Ageing 2021. [PMCID: PMC7989662 DOI: 10.1093/ageing/afab030.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The risk of severe morbidity after COVID-19 infection is high in older adults (Lithander et al, 2020). Subsequent responsive UK Government guidance for older adults included self-isolation during the pandemic. It is therefore hypothesised that during the pandemic older adults are inadvertently deconditioned due to iatrogenic factors such as inactivity, social isolation, hospital-avoidance and malnutrition, and present with reduced resilience to illness and lower levels of function. The OPU continued to admit COVID-negative, or recently termed “COVID-protected”, patients throughout the pandemic. Data captured prior to, and during the COVID-19 pandemic has been compared to explore the implications on older adults, and elicit whether they are protected from the consequences of the pandemic? Method Demographic and physical function data (average 6 m gait-speed, Elderly Mobility Scale) were captured pre- and through-pandemic for all patients admitted to a COVID-negative OPU ward over a one month period. Ethical review was provided through local Trust governance process. Results Pre-pandemic 2019 (n = 67, mean(±SD) age 82.7(±8.2) years, 61%, hospital length-of-stay (LOS) 7.9(±7.3) days, hospital mortality-rate 7.2%) and through-pandemic 2020 (n = 73, 83.1(±8.3) years, 59%♀, LOS 9.0(±9.1) days, hospital mortality-rate 7.5%) data were captured during July 2019 and May 2020 respectively. There were no between-group differences in age [t(−.313) = 138, p = 0.755], gender [X2, 1 df, p = 0.782], LOS [t(0.78) = 134, p = 0.44], or hospital mortality-rate [X2 1 df, p = 0.96]. Through-pandemic patients had a significantly slower 6 m gait-speed (0.11(±0.05) m.s-1) than pre-pandemic (0.16(±0.24) m.s-1); [t(2.74) = 93, p = 0.007] and lower median (IQR) Elderly Mobility Scale (4(6 IQR) vs 9 (12 IQR) [u = 866, p = 0.015]). Conclusion Our data indicates this relatively short period of self-isolation might have significant implications on the physical function of older adults. The likely mechanism is iatrogenic deconditioning. Critical Public Health and policy responses are required to mitigate these unforeseen risks by deploying prehabilitative counter-measures and accurately targeted hospital and community rehabilitation.
Collapse
Affiliation(s)
- S Ritchie
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - C Snape
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - N Triteos
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - R Vamadevan
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - L Olesk
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - C A Wood
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - G D Jones
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - J Jones
- Department of Physiotherapy, Older Person’s Unit (OPU), St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| |
Collapse
|
10
|
Banks DE, Carpenter RW, Wood CA, Winograd RP. Commentary on Furr-Holden et al. : As opioid overdose deaths accelerate among Black Americans, COVID-19 widens inequities-a critical need to invest in community-based approaches. Addiction 2021; 116:686-687. [PMID: 33417278 PMCID: PMC7878302 DOI: 10.1111/add.15362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has exacerbated racial inequities in fatal opioid overdoses affecting Black Americans. To reduce overdose rates among Black Americans, funding and policy efforts should prioritize local strategies that build community trust, such as grassroots organizations already engaged in outreach, advocacy, and harm reduction services.
Collapse
Affiliation(s)
- Devin E Banks
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
| |
Collapse
|
11
|
Winograd RP, Stringfellow EJ, Phillips SK, Wood CA. Some law enforcement officers’ negative attitudes toward overdose victims are exacerbated following overdose education training. The American Journal of Drug and Alcohol Abuse 2020; 46:577-588. [DOI: 10.1080/00952990.2020.1793159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Rachel P. Winograd
- St. Louis - Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Erin J. Stringfellow
- St. Louis - Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Sarah K. Phillips
- St. Louis - Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| | - Claire A. Wood
- St. Louis - Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, USA
| |
Collapse
|
12
|
Winograd RP, Phillips S, Wood CA, Green L, Costerison B, Goulka J, Beletsky L. Training to reduce emergency responders' perceived overdose risk from contact with fentanyl: early evidence of success. Harm Reduct J 2020; 17:58. [PMID: 32831088 PMCID: PMC7443848 DOI: 10.1186/s12954-020-00402-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA.
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | | | | | - Leo Beletsky
- Northeastern University, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Winograd RP, Wood CA, Stringfellow EJ, Presnall N, Duello A, Horn P, Rudder T. Implementation and evaluation of Missouri's Medication First treatment approach for opioid use disorder in publicly-funded substance use treatment programs. J Subst Abuse Treat 2019; 108:55-64. [PMID: 31277891 DOI: 10.1016/j.jsat.2019.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Leaders of Missouri's State Targeted Response to the opioid crisis (STR) grant have prioritized increasing access to treatment medications for opioid use disorder (MOUD) through a "Medication First" approach. This conceptual framework prioritizes rapid, sustained, low-barrier access to MOUD for optimal impact on decreased illicit drug use and mortality. Medication First principles and practices were facilitated through state-level structural changes and disseminated to participating community treatment programs via a multi-pronged, multi-disciplinary approach. In the first nine months of STR, 14 state-contracted treatment agencies operating 38 sites used STR funding to implement the Medication First model. METHODS We utilized state billing and service data to make comparisons before and during STR on the following outcomes: MOUD utilization, timely access to MOUD, amount of psychosocial services delivered, treatment retention at 1, 3, and 6 months, and monthly price of treatment. We conducted follow-up analyses examining differences across MOUD types (no medication, methadone, buprenorphine, oral naltrexone, mixed antagonist + agonist, and extended release naltrexone). RESULTS During STR, MOUD utilization increased (44.8% to 85.3%), timeliness of MOUD receipt improved (Median of 8 days vs. 0 days), there were fewer psychosocial services delivered, treatment retention improved at one, three, and six month timeframes, and the median cost per month was 21% lower than in the year prior to STR. All differences were driven by increased utilization of buprenorphine. CONCLUSIONS Findings suggest Medication First implementation through STR was successful in all targeted domains. Though much more work is needed to further reduce logistical, financial, and cultural barriers to improved access to maintenance MOUD, the steps taken through Missouri's STR grant show significant promise at making swift and drastic transformations to a system of care in response to a growing public health emergency.
Collapse
Affiliation(s)
- Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States.
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Erin J Stringfellow
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Ned Presnall
- Department of Psychiatry, Washington University, 1 Brookings Dr, St. Louis, MO 63130, United States
| | - Alex Duello
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Phil Horn
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Tim Rudder
- Missouri Department of Mental Health, 1706 East Elm St., Jefferson City, MO 65101, United States
| |
Collapse
|
14
|
Helms HM, Supple AJ, Hengstebeck ND, Wood CA, Rodriguez Y. Marital Processes Linking Gender Role Attitudes and Marital Satisfaction Among Mexican-Origin Couples: Application of an Actor-Partner Interdependence Mediation Model. Fam Process 2019; 58:197-213. [PMID: 29363745 DOI: 10.1111/famp.12338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Informed by dyadic approaches and culturally informed, ecological perspectives of marriage, we applied an actor-partner interdependence mediation model (APIMeM) in a sample of 120 Mexican-origin couples to examine (a) the associations linking Mexican immigrant husbands' and wives' gender role attitudes to marital satisfaction directly and indirectly through marital processes (i.e., warmth and negativity) and (b) whether the associations between spouses' gender role attitudes and marital processes were moderated by wives' employment. Although previous research has identified spouses' gender role attitudes as potential predictors of spouses' marital satisfaction, no study has examined these links in a dyadic model that elucidates how gender role attitudes may operate through processes to shape marital satisfaction and conditions under which associations may differ. We found that when spouses reported less sex-typed attitudes, their partners reported feeling more connected to them and more satisfied with the marriage, regardless of whether wives were employed. Our results suggest that marital satisfaction was highest for those Mexican-origin couples in which marital partners were less sex-typed in their attitudes about marital roles to the extent that partners' attitudinal role flexibility promoted spouses' feelings of warmth and connection to their partner.
Collapse
Affiliation(s)
- Heather M Helms
- Department of Human Development and Family Studies, University of North Carolina at Greensboro, Greensboro, NC
| | - Andrew J Supple
- Department of Human Development and Family Studies, University of North Carolina at Greensboro, Greensboro, NC
| | - Natalie D Hengstebeck
- Scholars Strategy Network and Duke University Sanford School of Public Policy, Durham, NC
| | - Claire A Wood
- Missouri Institute of Mental Health, Saint Louis, MO
| | - Yuliana Rodriguez
- Department of Human Development and Family Science, East Carolina University, Greenville, NC
| |
Collapse
|
15
|
Wood CA, Helms HM, Supple AJ, Perlman D. Gender-typed attributes and marital satisfaction among Mexican immigrant couples: A latent profile approach. J Fam Psychol 2015; 29:321-330. [PMID: 25915088 DOI: 10.1037/fam0000077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Informed by socioecological and dyadic approaches to understanding marriage, the current study examined the patterning of gender-typed attributes among 120 Mexican immigrant opposite sex couples and the subsequent links with spouses' reports of marital satisfaction. Latent profile analysis (LPA) was used to identify typologies of couples based on spouses' self-reported masculine and feminine attributes. Three couple profiles were identified: (a) Androgynous Couples, (b) Undifferentiated Couples, and (c) Mismatched Couples. Results from a mixed model ANCOVA showed profile differences in couples' marital satisfaction based on profile membership, suggesting that spouses in the Undifferentiated Profile were the least satisfied. Findings illustrate a lack of gender-typing at the individual and couple levels that challenge stereotypical and patriarchal depictions of Latino marital relationships and propose a more complex understanding of Mexican-origin spouses' gender-typed attributes than has yet been portrayed in the literature. The finding that couples with 1 androgynous partner (i.e., wives in the Mismatched Profile) reported similar levels of marital satisfaction to couples in the Androgynous Profile offers additional insights regarding how these qualities operate under the unique socioecological niches that Mexican immigrant couples inhabit-contexts that may place demands on spouses that challenge gendered and culturally bound depictions of marriage.
Collapse
|
16
|
Johnston EL, Marzinelli EM, Wood CA, Speranza D, Bishop JDD. Bearing the burden of boat harbours: heavy contaminant and fouling loads in a native habitat-forming alga. Mar Pollut Bull 2011; 62:2137-44. [PMID: 21820680 DOI: 10.1016/j.marpolbul.2011.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 07/01/2011] [Accepted: 07/03/2011] [Indexed: 05/27/2023]
Abstract
Boat harbours are an increasingly common form of artificial habitat. This paper presents a comparative study of contaminants and foulers of a habitat-forming native kelp (Saccharina latissima) in four marinas and four reference locations along the south-west coast of the UK. Fouling of algal laminae was light (<2% cover) in reference locations, while epibiota cover ranged from 25% to 80% of laminae in marinas. Metals associated with antifouling paints were up to six times more concentrated in algal tissues from marinas than from the reference locations. Marinas also carried the greatest cover and diversity of non-indigenous epibiota on the kelp laminae. This indicates not only a potential stress to kelps in these environments, but also the possibility that detached laminae will act as vectors for the dispersal of non-indigenous species. The development of boat harbours creates habitats that are high risk source localities for pollution-tolerant fouling organisms.
Collapse
Affiliation(s)
- E L Johnston
- Evolution and Ecology Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney NSW 2052, Australia.
| | | | | | | | | |
Collapse
|
17
|
Payne SE, Rassnick KM, Northrup NC, Kristal O, Chretin JD, Cotter SM, Kintzer P, Frimberger AE, Morrison-Collister KE, Wood CA, Moore AS. Treatment of vascular and soft-tissue sarcomas in dogs using an alternating protocol of ifosfamide and doxorubicin. Vet Comp Oncol 2009; 1:171-9. [PMID: 19379178 DOI: 10.1111/j.1476-5810.2003.00024.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A retrospective analysis was done to assess the toxicity and efficacy associated with an alternating chemotherapy protocol of ifosfamide (375 mg m(-2)) and doxorubicin (30 mg m(-2)) for adjuvant treatment of 39 dogs with sarcomas. Twelve dogs had various soft-tissue sarcomas and 27 dogs had hemangiosarcoma (HSA). Complete blood counts were evaluated 7 days after the first dose of ifosfamide and doxorubicin. One dog had grade 4 neutropenia (<500 microL(-1)) after treatment with ifosfamide and one dog had grade 3 neutropenia (500-1000 microL(-1)) after treatment with doxorubicin. One dog treated with doxorubicin was hospitalized for 24 h due to vomiting. The median survival time (ST) for the 27 dogs with HSA treated by surgery and with doxorubicin/ifosfamide was 149 days (mean 366 days). Although the protocol of alternating ifosfamide and doxorubicin was well tolerated, it failed to result in a statistically significant improvement in the ST when compared to a historical population of dogs with stage 2 splenic HSA treated by surgery alone.
Collapse
Affiliation(s)
- S E Payne
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Yakovlev SV, Stratchounski LS, Woods GL, Adeyi B, McCarroll KA, Ginanni JA, Friedland IR, Wood CA, DiNubile MJ. Ertapenem versus cefepime for initial empirical treatment of pneumonia acquired in skilled-care facilities or in hospitals outside the intensive care unit. Eur J Clin Microbiol Infect Dis 2007; 25:633-41. [PMID: 17024505 DOI: 10.1007/s10096-006-0193-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study presented here compared the efficacy and safety of ertapenem and cefepime as initial treatment for adults with pneumonia acquired in skilled-care facilities or in hospital environments outside the intensive care unit (ICU). Non-ventilated patients developing pneumonia in hospital environments outside the ICU, in nursing homes, or in other skilled-care facilities were enrolled in this double-blind non-inferiority study, stratified by APACHE II score (<or=15 vs >15) and randomized (1:1) to receive cefepime (2 g every 12 h with optional metronidazole 500 mg every 12 h) or ertapenem (1 g daily). After 3 days of parenteral therapy, participants demonstrating clinical improvement could be switched to oral ciprofloxacin or another appropriate oral agent. Probable pathogens were identified in 162 (53.5%) of the 303 randomized participants. The most common pathogens were Enterobacteriaceae, Streptococcus pneumoniae, and Staphylococcus aureus, isolated from 59 (19.5%), 39 (12.9%), and 35 (11.6%) participants, respectively. At the test-of-cure assessment 7-14 days after completion of all study therapy, pneumonia had resolved or substantially improved in 89 (87.3%) of 102 clinically evaluable ertapenem recipients and 80 (86%) of 93 clinically evaluable cefepime recipients (95% confidence interval for the difference, -9.4 to 11.8%), fulfilling pre-specified criteria for statistical non-inferiority. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. In this study population, ertapenem was as well-tolerated and efficacious as cefepime for the initial treatment of pneumonia acquired in skilled-care facilities or in hospital environments outside the ICU.
Collapse
Affiliation(s)
- S V Yakovlev
- Municipal Hospital #7, Moscow, and Smolensk State Medical Academy, Russia
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Simon D, Ruslander DM, Rassnick KM, Wood CA, Frimberger AE, Cotter SM, King NW, Moore AS. Orthovoltage radiation and weekly low dose of doxorubicin for the treatment of incompletely excised soft-tissue sarcomas in 39 dogs. Vet Rec 2007; 160:321-6. [PMID: 17351172 DOI: 10.1136/vr.160.10.321] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The efficacy and toxicity of orthovoltage radiation therapy and concurrent low doses of doxorubicin for the treatment of incompletely excised soft-tissue sarcomas in 39 dogs was investigated retrospectively. The 39 dogs had 40 soft-tissue sarcomas and received 51 Gy orthovoltage radiation in 17 daily 3 Gy fractions; they also received 10 mg/m(2) doxorubicin once a week administered intravenously one hour before the dose of radiation. The median follow-up time was 910 days. The tumours recurred locally in seven of the dogs, in five of them within the radiation field; the median time to their recurrence was 213 days (range 63 to 555 days). Six of the dogs developed a distant metastasis after a median time of 276 days (range eight to 826 days). The one-year and two- to four-year tumour control rates were 84 per cent and 81 per cent, respectively, and the one-, two- and three- to four-year survival rates were 85 per cent, 79 per cent and 72 per cent, respectively. Tumours with a mitotic rate of more than 9 per 10 high-power fields were significantly more likely to recur, and the dogs with such tumours survived for significantly shorter periods.
Collapse
Affiliation(s)
- D Simon
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Pemberton AJ, Sommerfeldt AD, Wood CA, Flint HC, Noble LR, Clarke KR, Bishop JDD. Plant-like mating in an animal: sexual compatibility and allocation trade-offs in a simultaneous hermaphrodite with remote transfer of sperm. J Evol Biol 2004; 17:506-18. [PMID: 15149394 DOI: 10.1111/j.1420-9101.2004.00708.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The importance of sexual compatibility between mates has only recently been realized in zoological research into sexual selection, yet its study has been central to botanical research for many decades. The reproductive characteristics of remote mating, an absence of precopulatory mate screening, internal fertilization and embryonic brooding are shared between passively pollinated plants and a phylogenetically diverse group of sessile aquatic invertebrates. Here, we further characterize the sexual compatibility system of one such invertebrate, the colonial ascidian Diplosoma listerianum. All 66 reciprocal pairings of 12 genetic individuals were carried out. Fecundities of crosses varied widely and suggested a continuous scale of sexual compatibility. Of the 11 animals from the same population c. 40% of crosses were completely incompatible with a further c. 20% having obvious partial compatibility (reduced fecundity). We are unaware of other studies documenting such high levels of sexual incompatibility in unrelated individuals. RAPD fingerprinting was used to estimate relatedness among the 12 individuals after a known pedigree was successfully reconstructed to validate the technique. In contrast to previous results, no correlation between genetic similarity and sexual compatibility was detected. The blocking of many genotypes of sperm is expected to severely modify realized paternity away from 'fair raffle' expectations and probably reduce levels of intra-brood genetic diversity in this obligatorily promiscuous mating system. One adaptive benefit may be to reduce the bombardment of the female reproductive system by outcrossed sperm with conflicting evolutionary interests, so as to maintain female control of somatic : gametic investment.
Collapse
Affiliation(s)
- A J Pemberton
- Marine Biological Association of the UK, Citadel Hill Laboratory, Plymouth, Devon, UK.
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
A colloidal dispersion formulation of 9-aminocamptothecin (9-AC) was administered intravenously to 10 dogs with previously untreated, spontaneously occurring, multicentric lymphoma. The dogs received a 72-h infusion of 9-AC at a rate of 46.5-51.25 microg m(-2) h(-1) (total dose range 3.35-3.69 mg m(-2)). This dose range was associated with myelosuppression, consisting principally of neutropenia with a nadir at 7 days following the start of infusion. Neutropenia and thrombocytopenia were the most common toxicoses and are most likely to be dose-limiting toxicities; low-grade gastrointestinal signs were rarely seen. Concentrations of 9-AC lactone, as well as clinical toxicities, compare favourably with those found in humans. Tumour responses were seen in all treated dogs. Response to other chemotherapy, following cessation of 9-AC treatment, was not obviously compromised even in dogs clinically resistant to 9-AC. 9-AC is a novel treatment drug for canine lymphoma, which appears to show great promise.
Collapse
Affiliation(s)
- A S Moore
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA.
| | | | | | | |
Collapse
|
22
|
Stephenson C, Wood CA, Henriques MA, Magers TL, Wilson K. God's work: can we teach Christian caring? J Christ Nurs 2002; 15:26-31. [PMID: 11799880 DOI: 10.1097/00005217-199815030-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- C Stephenson
- Faculty of Mississippi College of Nursing, Clinton, Mississippi, USA
| | | | | | | | | |
Collapse
|
23
|
Linden PK, Moellering RC, Wood CA, Rehm SJ, Flaherty J, Bompart F, Talbot GH. Treatment of vancomycin-resistant Enterococcus faecium infections with quinupristin/dalfopristin. Clin Infect Dis 2001; 33:1816-23. [PMID: 11668430 DOI: 10.1086/323899] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2001] [Revised: 06/08/2001] [Indexed: 11/03/2022] Open
Abstract
Clinicians caring for patients with vancomycin-resistant Enterococcus faecium (VREF) infections face severe constraints in the selection of treatment. Quinupristin/dalfopristin (Synercid) is active in vitro against VREF, with a MIC(90) of 1.0 microg/mL. We investigated the clinical efficacy and safety of this agent in a multicenter, prospective, noncomparative, emergency-use study of 396 patients. Patients were included if they had signs and symptoms of active infection, including bacteremia of unknown origin, intra-abdominal infection, and skin and skin-structure infection, with no alternative antibiotic therapy available. The mean duration of treatment was 20 days (range, 4-40 days). The clinical response rate was 68.8% in the evaluable subset, and the overall response rate was 65.6%. The most common adverse events related to quinupristin/dalfopristin were arthralgias and myalgias. Related laboratory abnormalities were rare. In this severely ill patient population, quinupristin/dalfopristin was efficacious and demonstrated an acceptable safety profile in the treatment of VREF infection.
Collapse
Affiliation(s)
- P K Linden
- University of Pittsburgh Medical Center, Division of Critical Care Medicine, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
Wood CA, Lee K, Vaisberg AJ, Kingston DG, Neto CC, Hammond GB. A bioactive spirolactone iridoid and triterpenoids from Himatanthus sucuuba. Chem Pharm Bull (Tokyo) 2001; 49:1477-8. [PMID: 11724243 DOI: 10.1248/cpb.49.1477] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Himatanthus sucuuba is an Amazonian tree with abundant, yet conflicting ethnobotanical information. Investigation of the polar and non-polar constituents led to the isolation of plumericin, a bioactive spirolactone iridoid, and four known pentacylic triterpenes: lupeol acetate, lupeol cinnamate, lupeol beta-phenyl propionate, and alpha-amyrin cinnamate.
Collapse
Affiliation(s)
- C A Wood
- Department of Chemistry and Biochemistry, University of Massachusetts-Dartmouth, 02747, USA
| | | | | | | | | | | |
Collapse
|
25
|
Moore AS, Cotter SM, Rand WM, Wood CA, Williams LE, London CA, Frimberger AE, L'Heureux DA. Evaluation of a discontinuous treatment protocol (VELCAP-S) for canine lymphoma. J Vet Intern Med 2001; 15:348-54. [PMID: 11467592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Eighty-two dogs with lymphoma received a single 15-week course of chemotherapy, after which treatment was ceased until relapse. Fifty-six dogs (68%) achieved complete remission for a median 1st remission duration of 20 weeks. Forty-eight dogs relapsed, of which 30 repeated the induction cycle. In 22 of these dogs, 1st remission had been short, and they received maintenance chemotherapy; the other 8 dogs received 2 or 3 cycles of induction chemotherapy. Second remission rate for these 30 dogs was 87% (26 dogs). Overall disease control for the 38 dogs that remained on protocol was 44 weeks, which was not markedly shorter than for dogs treated with a previously reported protocol in which maintenance chemotherapy was instituted in all dogs after an identical 1st induction (VELCAP-L). Dogs that were febrile and dogs that were dyspneic were less likely to achieve a complete remission to induction chemotherapy. Of dogs that achieved a complete remission, those that were thrombocytopenic at entry had a shorter 1st remission, and dogs that were anorexic at entry had shorter overall disease control. There was a correlation between 1st remission duration and length of any subsequent remission obtained. The incidence of toxicity was high, particularly after the combination of doxorubicin and vincristine. Dose reductions because of toxicity did not markedly reduce remission duration. We conclude that discontinuous chemotherapy may reduce patient visits in a small number of patients because of long-term disease control. Delaying maintenance chemotherapy until after 2nd remission is achieved does not markedly affect overall disease control.
Collapse
Affiliation(s)
- A S Moore
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
lfosfamide (3-[2-chloroethyl]-2[(2 chloroethyl)amino]tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide) is an alkylating agent with a broad spectrum of antitumor activity. The efficacy and toxicity of ifosfamide were evaluated in 72 dogs with spontaneously occurring tumors. Forty dogs (56%) had lymphoma, 31 (43%) had sarcomas, and 1 had a metastatic carcinoma. Five dogs received ifosfamide at dosages <350 mg/m2 IV. Neither toxicity nor response were observed, and the remaining dogs received ifosfamide at 350 mg/m2 (n = 18) and 375 mg/m2 body surface area IV (n = 49). Saline diuresis and the thiol compound mesna were used to prevent urothelial toxicity. Fifty-two dogs had measurable tumors and could be evaluated for response. Complete responses were seen in 1 dog with metastatic leiomyosarcoma of the urinary bladder and in 1 dog with metastatic cutaneous hemangiosarcoma. One dog with lymphoma had a partial response for 112 days. Six dogs with splenic hemangiosarcoma received ifosfamide postsplenectomy and their median survival time was 147 days. The acute dose limiting toxicity was neutropenia 7 days after administration of ifosfamide. The median and mean neutrophil counts 7 days after ifosfamide at 350 mg/m2 were 2,035 cells/microL and 4,773 cells/microL, respectively (n = 12). The median and mean neutrophil counts 7 days after ifosfamide at 375 mg/m2 were 2,500 cells/microL and 3,594 cells/microL, respectively (n = 37). No dog developed clinical or microscopic evidence of hemorrhagic cystitis. Ifosfamide appears safe to use in tumor-bearing dogs, and the evaluation of combination chemotherapy protocols that include ifosfamide should be considered.
Collapse
Affiliation(s)
- K M Rassnick
- Harrington Oncology Program, School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
Orthovoltage radiation was used to treat odontogenic tumours in three cats following incomplete surgical resection. Cats received a total radiation dose of 48-52 Gy over a period of 26-29 days. Acute toxicities were mild, consisting of hair loss within the radiation field in all cats, and mild mucositis in one cat. All cats had long-term (>35 months) control of their tumour, and two cats are still alive without recurrence of tumour 60 and 39 months, respectively, after completing treatment. Radiation therapy should be considered to be an adjuvant to incomplete surgery in cats with odontogenic neoplasms or epulides.
Collapse
Affiliation(s)
- A S Moore
- Harrington Oncology Program, Department of Clinical Sciences, Tufts University School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Forty-three dogs with lymphoma that had relapsed or had failed to achieve complete remission to previous chemotherapy were treated with lomustine (1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea [CCNU]) at a dosage of 90-100 mg/m2 body surface area p.o. every 3 weeks. Durable complete or partial responses occurred in 11 dogs for a median of 86 days. The acutely dose-limiting toxicosis was neutropenia 7 days after administration, resulting in a recommended dosage of 90 mg/m2. Cumulative thrombocytopenia occurred in dogs receiving continued CCNU treatment, and a dose interval of 3 weeks may be too short for continued administration of this drug. Toxicoses evident as fever or central nervous system signs or renal damage were uncommon or rare. CCNU is effective in the treatment of relapsed lymphoma.
Collapse
Affiliation(s)
- A S Moore
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
OBJECTIVE To compare the distribution of cataract types between psychiatric patients diagnosed with schizophrenia and the general population not exposed to psychotropic medication, and to compare cataract prevalence between users and nonusers of various psychotropic medications in the general community. DESIGN Case-control. PARTICIPANTS A total of 151 (93%) eligible patients from a community mental health service and 3271 (83%) eligible residents from the Melbourne Visual Impairment Project (VIP) were examined. MAIN OUTCOME MEASURES All patients 40 years of age and older from a community mental health service and residents of nine randomly selected areas of Melbourne were eligible. Best-corrected distance visual acuity was determined using a 4-m logarithm of the minimum angle of resolution (LogMAR) chart. The presence of cataract was determined by photographs or slit-lamp examination using direct and indirect retroillumination. Anterior, cortical, nuclear, and posterior subcapsular cataracts were measured. Participants from the Melbourne VIP were classified as to whether they had taken benzodiazepams, phenothiazines, thioxanthenes, butyrophenols, tricyclic antidepressants, or monoamine oxidase inhibitors for at least 12 months during their lifetime. RESULTS The distribution of cataract type varied between persons with and without schizophrenia. Anterior subcapsular (ASC) cataract was significantly more prevalent (26%) in participants with schizophrenia from the community mental health service than Melbourne VIP participants (0.2%) not exposed to psychotropic medication (chi-square, 1 degree of freedom = 605.5, P = 0.001). This remained significant after controlling for age (odds ratios = 250, 95% confidence interval = 83.3, 1000). The distribution of the age-related cataract was similar across all groups of psychotropic medication users with the exception of the phenothiazine users. They had less of all types of the age-related cataracts, despite being slightly older than the control group (mean age, 60.0 vs. 58.4, t test = 0.85, P = 0.40). However, only cortical cataract in the phenothiazine group was statistically lower (chi-square, 1 degree of freedom = 3.96, P = 0.047). CONCLUSION This study has identified the need to investigate whether other newer agents, especially high-potency medications, cause ASC opacities if a certain threshold of exposure to psychotropic medications must be attained to develop cataract, or if schizophrenia itself is associated with cataract formation.
Collapse
Affiliation(s)
- C A McCarty
- Centre for Eye Research Australia, The University of Melbourne, Department of Ophthalmology, Vic
| | | | | | | | | | | | | |
Collapse
|
30
|
Zemann BI, Moore AS, Rand WM, Mason G, Ruslander DM, Frimberger AE, Wood CA, L'Heureux DA, Gliatto J, Cotter SM. A combination chemotherapy protocol (VELCAP-L) for dogs with lymphoma. Vet Med (Auckl) 1998; 12:465-70. [PMID: 9857340 DOI: 10.1111/j.1939-1676.1998.tb02151.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ninety-eight dogs with lymphoma treated with a 5-drug combination chemotherapy regimen (vincristine, L-asparaginase, cyclophosphamide, doxorubicin, prednisone [VELCAP-L]) were evaluated for pretreatment characteristics predictive for response and remission duration. The complete remission rate was 69%, with a median remission duration of 55 weeks. Dogs with advanced stage of disease, constitutional signs, dogs that were older, and dogs that were dyspneic were less likely to achieve remission. Once in remission, small dogs and dogs without pretreatment thrombocytopenia were likely to have longer remission duration. Toxicoses were frequent, but rarely fatal, and no predictitive factors were found for a dog developing toxicoses. VELCAP-L is an effective treatment for dogs in stage I-III lymphoma, particularly in young, small animals.
Collapse
Affiliation(s)
- B I Zemann
- School of Veterinary Medicine, Vienna, Austria
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Wood CA, Moore AS, Gliatto JM, Ablin LA, Berg RJ, Rand WM. Prognosis for dogs with stage I or II splenic hemangiosarcoma treated by splenectomy alone: 32 cases (1991-1993). J Am Anim Hosp Assoc 1998; 34:417-21. [PMID: 9728473 DOI: 10.5326/15473317-34-5-417] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A retrospective analysis was performed on the case records of 32 dogs with Stage I or II splenic hemangiosarcoma that were treated by splenectomy alone and that survived the seven-day postoperative period. Median survival time for these 32 cases was 86 days (mean, 116 days; range, 14 to 470 days), and the one-year survival rate was estimated to be 6.25%. Survival was not influenced by signalment, presenting signs, stage of disease, or clinicopathological findings. The data provides a basis from which to evaluate adjuvant chemotherapy for splenic hemangiosarcoma that is confined to the spleen macroscopically.
Collapse
Affiliation(s)
- C A Wood
- Department of Medicine, Tufts University School of Veterinary Medicine, North Grafton, Massachusetts 01536, USA
| | | | | | | | | | | |
Collapse
|
32
|
Livingston PM, Wood CA, McCarty CA, Harper CA, Keeffe JE, Taylor HR. Awareness of diabetic retinopathy among people who attended a diabetic retinopathy screening program. Med J Aust 1998; 169:117. [PMID: 9700352 DOI: 10.5694/j.1326-5377.1998.tb140205.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
33
|
Wood CA, Abrutyn E. Urinary tract infection in older adults. Clin Geriatr Med 1998; 14:267-83. [PMID: 9536105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Urinary tract infection is common among older adults, although most individuals are asymptomatic. The prevalence of bacteriuria varies significantly with living situation and functional status. Asymptomatic bacteriuria is a benign condition and is not an independent risk factor for mortality in older adults. Treatment of asymptomatic bacteriuria generally is not indicated, but symptomatic urinary tract infection of the lower or upper tract dictates antibiotic therapy.
Collapse
Affiliation(s)
- C A Wood
- Division of Infectious Diseases, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania 19102, USA
| | | |
Collapse
|
34
|
Livingston PM, McCarty CA, Wood CA, Harper AC, Keeffe JE, Taylor HR. Use of focus groups to identify health promotion strategies for the early detection of diabetic retinopathy. Aust N Z J Public Health 1998; 22:220-2. [PMID: 9744180 DOI: 10.1111/j.1467-842x.1998.tb01176.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND People with diabetes do not regularly utilise eye services for the early prevention of vision loss due to diabetic eye disease. A community-based screening program has been initiated in Victoria to address this issue. To encourage people to take preventive eye health care measures, the most effective health promotion strategies were identified. METHODS Thirty-three health professionals were invited to attend focus groups. A sample of 35 people with diabetes was approached by their GPs or diabetes educators because of their motivation to participate in diabetes activities. Each group consisted of 10 members. Discussion points included the type of education messages available to people with diabetes; use of eye services among the participants with diabetes; and strategies required promoting the screening service. RESULTS Five focus groups were conducted. The discussions highlighted that a great deal could be achieved by using local community networks to promote the benefits of early detection of diabetic retinopathy and local screening program. The group members recommended that particular attention be directed to general practitioners and their distribution of materials to patients. Key issues for planning and implementing the program were highlighted. The groups urged development of strategies to encourage people with diabetes in rural Victoria to participate in a program for the early detection of diabetic retinopathy.
Collapse
Affiliation(s)
- P M Livingston
- Anti-Cancer Council of Victoria, Centre for Behavioural Research in Cancer, Carlton.
| | | | | | | | | | | |
Collapse
|
35
|
Livingston PM, Wood CA, Butler M, Oh J, Keefe JE, Taylor HR. General practitioners are the most important conveyors of information to their patients regarding diabetic retinopathy. Diabetes Care 1998; 21:324-5. [PMID: 9540007 DOI: 10.2337/diacare.21.2.324b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
36
|
Samuels LE, Sharma S, Morris RJ, Solomon MP, Granick MS, Wood CA, Brockman SK. Mycobacterium fortuitum infection of the sternum. Review of the literature and case illustration. Arch Surg 1996; 131:1344-6. [PMID: 8956778 DOI: 10.1001/archsurg.1996.01430240098014] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sternal wound infection with atypical mycobacteria following open heart surgery is a rare occurrence. Previous reports have described infection by Mycobacterium fortuitum, an acid-fast bacillus and member of a larger family of rapidly growing mycobacteria. The source and mode of transmission have not been identified. Surgical debridement and the combination of aminoglycosides and quinolones have been shown to be effective methods of treatment. More recently, clarithromycin has been shown to be the drug of choice against rapidly growing mycobacteria. We describe a 49-year-old woman who underwent infundibular stenosis repair and in whom M fortuitum sternal osteomyelitis developed. Total sternectomy, muscle flap reconstruction, and antibiotic treatment successfully eradicated the infection.
Collapse
Affiliation(s)
- L E Samuels
- Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, Pa, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Elderly patients are at high risk for urinary tract infection (UTI). Infections of the urinary tract may be classified as asymptomatic bacteriuria, uncomplicated cystitis, uncomplicated pyelonephritis or complicated UTI. The micro-organisms responsible for causing UTI are largely predictable and dictate therapy when indicated. UTIs may be diagnosed by both nonculture and culture techniques. Asymptomatic bacteriuria, though quite common in the elderly, should rarely be treated. Treatment of symptomatic uncomplicated and complicated UTIs is largely dictated by the known or expected pathogen(s) and classification of the infection. Additional features affecting the treatment of UTI in the elderly include allergies, adverse reactions to therapy, drug interactions and modification for renal insufficiency.
Collapse
Affiliation(s)
- C A Wood
- Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
38
|
Moore AS, Cotter SM, Frimberger AE, Wood CA, Rand WM, L'Heureux DA. A comparison of doxorubicin and COP for maintenance of remission in cats with lymphoma. J Vet Intern Med 1996; 10:372-5. [PMID: 8947869 DOI: 10.1111/j.1939-1676.1996.tb02083.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Thirty-eight cats with lymphoma were treated with vincristine, cyclophosphamide, and prednisone (COP). They were randomized at entry to receive maintenance chemotherapy consisting of either single-agent doxorubicin or continued COP therapy, starting on week 4 of treatment and continuing for 6 months or until relapse. Eighteen cats achieved complete clinical remission after COP induction chemotherapy. The median remission duration for 11 cats continuing to receive COP was 83 days, which was significantly shorter than for 7 cats that received doxorubicin (281 days). Thus, doxorubicin should be considered a well-tolerated and efficacious agent for the maintenance of remission in cats with lymphoma.
Collapse
Affiliation(s)
- A S Moore
- Department of Small Animal Medicine, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
| | | | | | | | | | | |
Collapse
|
39
|
Wood CA. Oral ganciclovir as prophylaxis against cytomegalovirus. N Engl J Med 1996; 335:1395; author reply 1396-7. [PMID: 8927069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
40
|
Anderson YS, Wood CA, Radda GK. Glycogen metabolism in G8 mouse muscle cells. Biochem Soc Trans 1995; 23:319S. [PMID: 7672350 DOI: 10.1042/bst023319s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Y S Anderson
- Department of Biochemistry, University of Oxford
| | | | | |
Collapse
|
41
|
Reboli AC, Houston ED, Monteforte JS, Wood CA, Hamill RJ. Discrimination of epidemic and sporadic isolates of Acinetobacter baumannii by repetitive element PCR-mediated DNA fingerprinting. J Clin Microbiol 1994; 32:2635-40. [PMID: 7852548 PMCID: PMC264134 DOI: 10.1128/jcm.32.11.2635-2640.1994] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In 1990, there was a significant increase in the number of lower respiratory tract infections and surgical wound infections in the adult intensive care units of our tertiary care teaching hospital caused by Acinetobacter baumannii compared with the number in 1989. During the 5-month period from April through August 1990, 84 isolates of A. baumannii were recovered from 50 hospitalized patients. Biotyping, comparison of antibiograms, plasmid analysis, and DNA polymorphisms of 20 isolates from 20 different patients, determined by the use of repetitive element PCR with primers aimed at repetitive extragenic palindromic sequences and enterobacterial repetitive intergenic consensus sequences, were used to investigate this apparent outbreak. Biotyping, antibiograms, plasmid analysis, and enterobacterial repetitive intergenic consensus PCR were not useful epidemiologically. Repetitive element PCR-mediated DNA fingerprinting using repetitive extragenic palindromic primers discriminated between epidemic and sporadic strains of A. baumannii and demonstrated four discrete clusters which were unique epidemiologically.
Collapse
Affiliation(s)
- A C Reboli
- Department of Medicine, Hahnemann University, Philadelphia, Pennsylvania 19102
| | | | | | | | | |
Collapse
|
42
|
|
43
|
|
44
|
Wood CA, Wisniewski RM. Beta-lactams versus glycopeptides in treatment of subcutaneous abscesses infected with Staphylococcus aureus. Antimicrob Agents Chemother 1994; 38:1023-6. [PMID: 8067732 PMCID: PMC188144 DOI: 10.1128/aac.38.5.1023] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The antibacterial efficacies of the beta-lactam antibiotics nafcillin and cefazolin were compared with those of the glycopeptide antibiotics vancomycin and teicoplanin in rats with subcutaneous abscesses infected with methicillin-susceptible Staphylococcus aureus. Animals were treated with antibiotics or diluent for 3 or 7 days. Rats receiving any antibiotic treatment, with the exception of teicoplanin-treated animals at day 7, had lower bacterial counts in their abscesses than did controls at days 3 and 7. Rats in the nafcillin and cefazolin treatment groups had lower bacterial counts in their abscesses than did rats in the vancomycin and teicoplanin treatment groups at days 3 and 7. The beta-lactam antibiotics were more effective therapy than the glycopeptide antibiotics in rats with subcutaneous abscesses infected with methicillin-susceptible S. aureus. In vitro, animal, and clinical data comparing beta-lactam and glycopeptide treatment of S. aureus infections were reviewed along with the resulting treatment recommendations.
Collapse
Affiliation(s)
- C A Wood
- Department of Medicine, Hahnemann University, Philadelphia, Pennsylvania 19102
| | | |
Collapse
|
45
|
|
46
|
|
47
|
Padmore L, Wood CA, Radda GK. Receptor derived phosphatidic acid is used in the biosynthetic pathway of phosphatidylinositol. Biochem Soc Trans 1993; 21:362S. [PMID: 8131940 DOI: 10.1042/bst021362s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L Padmore
- Department of Biochemistry, University of Oxford
| | | | | |
Collapse
|
48
|
|
49
|
|
50
|
Affiliation(s)
- C A Wood
- Department of Biochemistry, University of Oxford
| | | | | |
Collapse
|