1
|
An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders. J Clin Med 2024; 13:2154. [PMID: 38610919 PMCID: PMC11012938 DOI: 10.3390/jcm13072154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.
Collapse
|
2
|
Understanding the research capacity of alcohol and other drugs services in New South Wales, Australia. Drug Alcohol Rev 2024; 43:265-277. [PMID: 38009912 DOI: 10.1111/dar.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Enhancing health system research capacity can support improved quality care. This study assessed the research capacity of public local health district (LHD) and non-government organisation (NGO) alcohol and other drug (AOD) services, at the organisational, team and individual level. Research barriers and motivators were also examined. METHODS Staff from LHD and NGO AOD treatment services in New South Wales completed an online survey using the Research Capacity and Culture (RCC) tool. Overall median research capacity scores are presented for the RCC subscales (organisational, team and individual). Comparisons were conducted by service type (LHD/NGO), geographical location (metropolitan/rural) and affiliation with a research network (yes/no). Qualitative questions explored barriers and motivators to research at individual and team levels. RESULTS Of 242 participants, 55% were LHD-based and 45% NGO-based. Overall RCC scores indicated moderate research capacity at all levels. Organisational capacity (Med = 6.50, interquartile range [IQR] = 3.50) scored significantly higher than the team (Med = 5.00, IQR = 6.00) and individual level (Med = 5.00, IQR = 4.25). No differences in RCC scores existed between NGOs and LHDs. Metropolitan AOD services scored higher research capacity at the organisational level (Med = 7.00, IQR = 3.00) than rural services (Med = 5.00, IQR = 5.00). LHDs affiliated with a research network scored significantly higher at the organisational, team and individual level than non-affiliated LHD services. Key research barriers were inadequate time and funding. Motivators included skill development and problem-identification requiring change. DISCUSSIONS AND CONCLUSIONS AOD services in New South Wales have moderate research capacity. Identified barriers and motivators can be used to target responses that enhance capacity and improve treatment outcomes.
Collapse
|
3
|
Vale Jude Byrne. Drug Alcohol Rev 2023; 42:505-506. [PMID: 36939493 DOI: 10.1111/dar.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/21/2023]
|
4
|
Isotonitazene, a novel psychoactive substance opioid, detected in two cases following a local surge in opioid overdoses. QJM 2023; 116:115-119. [PMID: 35169852 DOI: 10.1093/qjmed/hcac039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Isotonitazene is a novel opioid that was first reported in Europe in 2019. There have been no reports of the detection of isotonitazene in patients presenting to the emergency department with acute drug toxicity. AIM There was an increase in presentations to our emergency department with acute opioid toxicity in August 2021. We aim to describe this outbreak and provide detail on two cases in which isotonitazene was quantified in serum samples. METHODS Serum samples were available for comprehensive toxicological analysis for two presentations. Written consent was obtained and the samples were analysed through a Thermo XRS ultrahigh-performance liquid chromatography system, interfaced to a Thermo Q Exactive high-resolution accurate mass spectrometer, operating in heated positive ion electrospray mode. Acquired data were processed using Toxfinder software (Thermo) against a regularly updated in-house database. RESULTS There was an increase in acute opioid presentations to our emergency department from a median of 10 per month to 36 in August 2021. Twenty were treated with naloxone, and 23 were admitted to the hospital for observation and treatment. Serum sample analysis from two patients with acute opioid toxicity responsive to naloxone detected the presence of isotonitazene (0.18 and 0.81 ng/ml). CONCLUSION We report a cluster of acute opioid toxicity presentations to our Emergency Department with detection of isotonitazene in two cases. Analytical screening is important in determining the presence of novel psychoactive substances (NPS) and to help inform the public health of the implications of NPS use, particularly during clusters of acute recreational drug toxicity presentations.
Collapse
|
5
|
TARGETED THERAPY INCREASES PD-L1 PROTEIN EXPRESSION IN CELL LINES OF MEDIASTINAL LYMPHOMA. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
Improving access to drug and alcohol treatment in NSW Australia: The role of self-determination and peer support. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2050-e2057. [PMID: 34750909 DOI: 10.1111/hsc.13639] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 09/16/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
One of the key issues in the alcohol and other drug (AOD) treatment sector concerns the reported difficulties that clients have in accessing treatment. This paper draws on qualitative interview data collected from clients undergoing treatment (n = 20) and stakeholders (n = 15) of five specialist non-government AOD treatment services in New South Wales, Australia, to offer an in-depth perspective about treatment entry experiences. We identified four key themes of positive treatment entry experiences: the presence of high-quality online information which enabled clients to best match themselves to treatment; flexible and simple intake procedures with skilled and welcoming staff; the presence and quality of social and other resources (such as families, peers and private health insurance) which enabled quicker access; and prior experience in the treatment system which helped clients to gain important knowledge and skills to improve future access. We discuss implications of these findings, including that waiting lists significantly exacerbate inequity, but that this could be ameliorated by providing peer-support to those trying to gain entry, especially clients who do not have family and friends for help during this period. The findings also point to the way that client self-determination is central to all positive treatment entry experiences, and that supporting clients to find 'the right fit' in relation to treatment options improves their experiences.
Collapse
|
7
|
Clinical features associated with ADB-BUTINACA exposure in patients attending emergency departments in England. Clin Toxicol (Phila) 2022; 60:1094-1098. [PMID: 35943421 DOI: 10.1080/15563650.2022.2101469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Synthetic cannabinoid receptor agonists (SCRA) are commonly encountered new psychoactive substances. Here we report the recent detection of ADB-BUTINACA in samples from patients attending United Kingdom emergency departments with toxicity after suspected drug misuse and describe the associated clinical features. METHODS Consenting adults (≥16 y) presenting to participating hospitals with toxicity after suspected drug misuse have been included in the Identification Of Novel psychoActive substances (IONA) study since March 2015. Demographic and clinical features are recorded and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry. RESULTS By December 2021, analytical data were available for 1279 IONA participants and ADB-BUTINACA was detected in at least one sample from 10 (9 males, age range 16-51 median 45 years), all presenting since February 2021. Smoking 'spice' was reported by four patients, two had ingested edible "cannabis" gums and four reported heroin use (2 intravenous, 1 smoked, 1 route not known). Co-use of pregabalin (oral) and crack cocaine (smoked) were also reported. In 3 cases ADB-BUTINACA was the only substance detected, while in seven other substances of misuse were also detected including other SCRA, opioids, benzodiazepines cocaine and pregabalin. Clinical features reported in these 2 groups respectively included reduced level of consciousness (3/3, 6/7), agitation (0/3, 4/7), tachycardia (0/3, 3/7), seizures (1/3, 1/7), hallucinations (1/3, 1/7), hypotension (1/3, 1/7). Metabolic acidosis (1/3, 0/7) and respiratory acidosis (1/3, 0/7), All 10 patients recovered with supportive care, including intubation and ventilation for one case. The median length of hospital stay was 19 h (range 2.6-131 h). CONCLUSIONS ADB-BUTINACA has recently emerged as a drug of misuse in England. Clinical features of toxicity are consistent with those of other SCRA and include reduced level of consciousness, respiratory and/or metabolic acidosis, seizures, confusion and hallucinations.
Collapse
|
8
|
Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
Collapse
|
9
|
P.61 Women's experience of information regarding analgesia and anaesthesia prior to and during delivery. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Severe toxicity involving N-pyrrolidino etonitazene in the United Kingdom-a case report. Clin Toxicol (Phila) 2021; 60:533-534. [PMID: 34528860 DOI: 10.1080/15563650.2021.1979235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
11
|
Polysubstance use classes and health outcomes among women attending specialist substance use treatment services. Drug Alcohol Rev 2021; 41:488-500. [PMID: 34405938 DOI: 10.1111/dar.13375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Substance use is increasingly prevalent among women. Little research examines subgroups of women with substance use issues to identify their characteristics and thus enable treatment recommendations. The present study used latent class analysis to identify subgroups of substance use among women in substance-use treatment based on use in the 30 days prior to intake and examined changes in mental health and treatment outcomes following 60 days of treatment. METHODS Participants were women (N = 493) attending specialist non-government substance use treatment services in New South Wales, Australia. RESULTS Four distinct classes of substance users were identified: (i) Amphetamine Type Stimulants (ATS) Polysubstance (40.6%, n = 200); (ii) Alcohol Only (33.1%, n = 163); (iii) Cannabis and Alcohol (17.0%, n = 84) and (iv) Other Polysubstance (9.3%, n = 46). Women in the ATS Polysubstance class were the youngest and those in the Alcohol Only class were the oldest. DISCUSSION AND CONCLUSIONS Findings show that classes with high polysubstance use (ATS Polysubstance) differed from the single-substance use class (Alcohol Only). The ATS Polysubstance class had significantly greater improvements in health outcomes after 60 days compared to the Alcohol Only class. These findings suggest that although women with polysubstance use can benefit from substance use treatment, younger women (ATS Polysubstance) may benefit even more than older women (Alcohol Only). Future research should utilise a longitudinal design and examine additional psychosocial characteristics to extend on current findings.
Collapse
|
12
|
The sector is ready, and the community needs Australian alcohol and other drug treatment services to ask about sexuality and gender identity. Drug Alcohol Rev 2021; 41:39-42. [PMID: 34370883 DOI: 10.1111/dar.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
Sexuality and gender diverse Australians are a priority population in federal and state-based alcohol and other drug (AOD) strategies. Research evidence shows higher prevalence of AOD use by lesbian, gay, bisexual, transgender and queer (LGBTQ) people, riskier use and a higher proportion have accessed AOD treatment. Despite these disparities, Australian AOD treatment services do not routinely collect data on sexuality or gender identity. As a result, the treatment needs, experiences and outcomes of LGBTQ people remain largely invisible. The Australian Bureau of Statistics' recently released standardised indicators for the recording of sex, gender, variations of sex characteristics and sexual orientation presents an opportunity for the AOD sector to implement inclusive data collection as a foundational step towards achieving policy priorities for LGBTQ people. This commentary includes an implementation case study from the New South Wales non-government AOD treatment sector, where sexuality and gender identity indicators have been collected since 2016.
Collapse
|
13
|
Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase. Drug Alcohol Rev 2020; 40:540-552. [PMID: 33155315 DOI: 10.1111/dar.13191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. DESIGN AND METHODS ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). RESULTS Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. DISCUSSION AND CONCLUSIONS The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.
Collapse
|
14
|
Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
Collapse
|
15
|
A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
Collapse
|
16
|
Polysubstance use in treatment seekers who inject amphetamine: Drug use profiles, injecting practices and quality of life. Addict Behav 2017; 71:25-30. [PMID: 28242532 DOI: 10.1016/j.addbeh.2017.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/21/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The injection of amphetamine is becoming increasingly common. However, there has been a lack of research examining people who inject amphetamine as the primary drug of use, limiting the potential to ensure services address the unique needs of this group. The current study used latent class analysis to identify classes of polydrug use among people who report injecting amphetamine during the past 12months. It also examined differences between classes and drug use patterns, injecting practices, quality of life and psychological distress. METHODS Participants who were attending non-government specialist alcohol and other drug treatment across New South Wales, Australia and had identified amphetamine as their principle drug of concern and reported injecting amphetamine in the previous 12months were included in the current study (N=827). Latent class analysis was performed to identify polydrug profiles of participants. RESULTS The large majority of people in the current study (85%) demonstrated low probability of heroin or other opiate use. Three distinct classes of polydrug use were identified: (1) Low-polydrug (n=491), (2) Opiates-polydrug (n=123), and (3) Alcohol-polydrug (n=213). There was a trend for the Low-polydrug class to demonstrate better functioning and safer injecting practices than the Opiates-polydrug and Alcohol-polydrug classes. CONCLUSION The results suggest that the majority of people accessing treatment who inject amphetamine as their primary drug of choice have a low probability of heroin or other opiate use. It is important that future research consider whether traditional harm minimisation strategies are appropriate for people who primarily inject amphetamine.
Collapse
|
17
|
Equilibrium and Flux Surface Issues in the Design of the NCSX. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst07-a1296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
18
|
NCSX Magnetic Configuration Flexibility and Robustness. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst07-a1298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
19
|
Comparison of Parent and Child Rankings of Fruit and Vegetable Liking to Assess Parent Accuracy as Proxy Reporters. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
Collapse
|
21
|
Analysis of anonymized pooled urine in nine UK cities: variation in classical recreational drug, novel psychoactive substance and anabolic steroid use. QJM 2015; 108:929-33. [PMID: 25770158 DOI: 10.1093/qjmed/hcv058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Analysis of anonymous pooled urine samples from street urinals has been used to demonstrate time-trends in the detection of classical recreational drugs and novel psychoactive substances (NPS). AIM This study aimed to expand this to undertake a geographical trend analysis of classical recreational drugs/NPS across UK. METHODS Samples of anonymous pooled urine were collected from street urinals that had been in place for one night in April 2014 in nine cities across the UK. Collected samples were then analysed for the presence of recreational drugs, NPS anabolic steroids using high-performance liquid chromatography coupled to high-resolution accurate mass full-scan mass spectrometry and gas chromatography coupled to electron impact ionization mass spectrometry operating in selected ion monitoring and full-scan modes. RESULTS Ten classical recreational drugs, nine NPS and four anabolic steroids were detected across the nine cities; the range of detection was from 1 in Leeds to 14 in London. The most common classical drugs were cocaine (9 cities) and 3,4-methylenedioxy-methamphetamine (8 cities); the most common NPS was 4-methylmethcathinone (5 cities). In addition there was variation in the detection of NPS, with methylhexaneamine detected only in Bristol and London, piperazines (3-trifluoromethylphenylpiperazine and 1-benzylpiperazine) and pentedrone only detected in Birmingham and the cathinone methylone only detected in London. CONCLUSIONS There is variability in the detection of classical recreational drugs, NPS and anabolic steroids across UK, likely reflecting variation in their use. This technique can be used to supplement drug use surveys to determine geographical and time trends in the use of these substances. This is important to ensure appropriate targeting of drug-related interventions.
Collapse
|
22
|
Uncertainty and convenience: factors affecting attendance of musculoskeletal physiotherapy outpatient services in New Zealand. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.2122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Measuring maternal responsiveness in a community-based sample of slow-to-talk toddlers: a cross-sectional study. Child Care Health Dev 2015; 41:329-33. [PMID: 25039946 DOI: 10.1111/cch.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal responsiveness is important in early language development, but its measurement by direct observation has to date been unrealistic in community settings because of training and time constraints. We report on the development and cross-sectional comparison of a global rating of maternal responsiveness against a detailed measure of responsiveness at age 24 months. METHODS The community-based sample comprised 246 toddlers and their mothers, identified as being slow-to-talk at age 18 months within the Let's Learn Language population-based randomized controlled trial. At age 24 months, mother-child dyads were videotaped during 15 minutes of free-play and children undertook a standardized language assessment. Videos were blindly rated on both the new global measure, comprising a single rating of responsiveness on a five-point Likert scale, and a detailed rating of responsiveness known to predict language outcomes, comprising a sum of specific maternal responsive behaviours. RESULTS The global rating scale required relatively little training and ratings could be conducted in real time. The global and detailed ratings of maternal responsiveness showed moderate correlation (r = 0.44; P < 0.001). Small positive correlations were found between the global rating and expressive (r = 0.23; P < 0.001), receptive (r = 0.28, P < 0.001) and total language (r = 0.28; P < 0.001) at age 24 months. CONCLUSION The global rating scale was efficient and moderately effective as a measure of maternal responsiveness. It is possible that, combined with other risk measures including concurrent language skills, it could strengthen prediction of which children will and will not go on to experience lasting language difficulties.
Collapse
|
24
|
Delayed seizure-like activity following analytically confirmed use of previously unreported synthetic cannabinoid analogues. Hum Exp Toxicol 2014; 34:557-60. [DOI: 10.1177/0960327114550886] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Synthetic cannabinoid use has become widespread, leading to increased burdens on health care providers. Symptoms range from agitation and psychosis to seizures and acute kidney injury. We report a case where a patient was assessed and treated twice within 12 h for seizures following synthetic cannabinoid intoxication. Blood sample determinations showed low concentrations of analogues not previously reported, some of which are legal. Clinicians should be aware that synthetic cannabinoids may cause an array of severe health consequences. Given the ever evolving structure of available analogues, clinicians must also be prepared for other unexpected adverse effects.
Collapse
|
25
|
Analysis of Urine from Pooled Urinals - A Novel Method for the Detection of Novel Psychoactive Substances. ACTA ACUST UNITED AC 2014; 6:86-90. [DOI: 10.2174/1874473706666131205144014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/20/2013] [Accepted: 04/25/2013] [Indexed: 11/22/2022]
|
26
|
Trend analysis of anonymised pooled urine from portable street urinals in central London identifies variation in the use of novel psychoactive substances. Clin Toxicol (Phila) 2014; 52:160-5. [DOI: 10.3109/15563650.2014.885982] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
27
|
A randomised trial of weekend and evening breast screening appointments. Br J Cancer 2013; 109:597-602. [PMID: 23867998 PMCID: PMC3738129 DOI: 10.1038/bjc.2013.377] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: There is a need to research interventions that improve access to and convenience of breast cancer screening services. Methods: We conducted a randomised trial comparing invitations to out-of-hours appointments with standard office hour appointments. Women who were to be invited for routine breast screening were randomised (3 : 1 : 1 : 1) to one of these screening invitations: standard office hour appointment, office hour appointment with the option to change to an out-of-hours appointment, weekday evening appointment, or weekend appointment. Results: A total of 9410 women were invited to an office hour, 3519 to an office hour with the option to change, 3271 to a weekday evening, and 3162 to a weekend appointment. The offer of an initial out-of-hours appointment was associated with a non-significant decrease in attendance rates (73.7% vs 74.1%). The highest attendance was observed in the group offered an initial office hour appointment with the option to change to out-of-hours (76.1% vs 73.3% for standard office hour, P=0.001), with 7% of invitees exercising the option to change. Conclusion: The optimum strategy for improving attendance at breast screening is to offer a traditional office hour appointment and including in the letter of invitation an option to change to an evening or weekend appointment if wished.
Collapse
|
28
|
Taking the Pissoir – a novel and reliable way of knowing what drugs are being used in nightclubs. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2012.740139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Analysis of anonymous pooled urine from portable urinals in central London confirms the significant use of novel psychoactive substances. QJM 2013. [PMID: 23178933 DOI: 10.1093/qjmed/hcs219] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM Analysis of urine samples collected across a city centre, for the detection of novel psychoactive substances (NPS). DESIGN Cross-sectional study of anonymized urine samples used for the analysis of classical recreational drugs, NPS and metabolites. METHODS Pooled urine samples collected from portable stand-alone four-person urinals across a city centre were analysed using full-scan accurate-mass high-resolution liquid chromatography coupled to tandem mass spectrometry. Data were processed against compound databases containing >1700 drug compounds and metabolites. RESULTS Seven established recreational drugs (3,4-methylenedioxyamphetamine, cocaine, cannabis, ketamine, 3,4-methylenedioxy-N-methylamphetamine, methamphetamine and amphetamine) and six potential NPS [hordenine (all 12 urinals), cathine (11), methylhexaneamine (9), 4-methylmethcathinone (6), methiopropamine and metabolites (2) and methoxetamine and metabolites (1)] were detected. Methylhexaneamine, methiopropamine and hordenine are currently uncontrolled in the UK, whereas methoxetamine is currently subject to a Temporary Class Drug Order. Metabolites of the anabolic steroid nandrolone were found in two urinals and trenbolone metabolites and clenbuterol in one urinal. CONCLUSION Analysis of pooled urine samples collected anonymously from stand-alone urinals in a large inner city can detect the use of recreational drugs, NPS and anabolic steroids. Metabolite detection indicates actual drug use, metabolism and elimination rather than simply discarded drugs in the urinals. This technique by confirming the actual drug(s) used has the potential to be additive to currently used datasets/key indicators providing more robust information for healthcare authorities, legislative and law enforcement on the drugs actually being used.
Collapse
|
30
|
Identification of Acepromazine and Its Metabolites in Horse Plasma and Urine by LC–MS/MS and Accurate Mass Measurement. Chromatographia 2012. [DOI: 10.1007/s10337-012-2234-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
31
|
Patients' perspectives on medicines and pharmacy: views of patients with Type 2 diabetes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2001.tb01136.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
Collapse
|
32
|
Does social environment affect arthritis patients' ability to remain on methotrexate treatment? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2001.tb01135.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
Collapse
|
33
|
A patient-held medication record and a patient medication profile to support the continuity of acute cancer care. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2001.tb01100.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
Collapse
|
34
|
Defocus image contrast in hexagonally-ordered mesoporous material. Phys Chem Chem Phys 2011; 13:1189-200. [PMID: 21076765 DOI: 10.1039/c0cp01141j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A transmission electron microscope was used to characterize a powder form of hexagonally-ordered mesoporous silica material. The structural symmetry built into this amorphous material allowed one to obtain three characteristic images, i.e. a hexagonal honey-comb structure and wide/narrow parallel lines. These images were found to originate primarily from phase contrast, which changed sensitively with defocusing. To further understand the contrast behaviour of these images, an analytical form of the defocus contrast theory was developed and applied to the simulation of the characteristic wide/narrow parallel line images. The simulation was found to be in good qualitative agreement with experiments, where changes in focus conditions and specimen thickness were predicted to alter the contrast in the resulting parallel-line type images.
Collapse
|
35
|
Use of High-Resolution Accurate Mass Spectrometry to Detect Reported and Previously Unreported Cannabinomimetics in "Herbal High" Products. J Anal Toxicol 2010; 34:252-60. [DOI: 10.1093/jat/34.5.252] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
BHPR: Audit/Service Delivery [239-277]: 239. Arma-Based Audit of Rheumatology Service Delivered Predominantly Outside the Traditional Hospital Setting. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Treatment of Ovarian Hyperstimulation Syndrome Utilizing a Dopamine Agonist and Gonadotropin Releasing Hormone antagonist. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: results from a multi-city study of high-risk men who have sex with men in the USA. Sex Transm Infect 2009; 84:509-11. [PMID: 19028957 DOI: 10.1136/sti.2008.031807] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Men who have sex with men (MSM) who use alcohol and drugs are at especially high risk for sexually transmitted infections (STIs); more information is needed about associated factors to improve risk reduction. We assessed reported STIs and demographic and event-level alcohol and drug use characteristics associated with STIs in a diverse, multi-city study in the USA of MSM who use substances. Improved risk reduction efforts are needed for this group as well as some initiatives tailored to men who are HIV positive, younger and use drugs (not alcohol) in the context of anal sex.
Collapse
|
39
|
How does the location of a satellite screening site affect uptake? Breast Cancer Res 2008. [PMCID: PMC3332592 DOI: 10.1186/bcr2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
40
|
Characterization of comorbidities, functional status, and symptoms in patients 75–89 years of age at a cancer center. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
41
|
Abstract
One year in and we are now starting to see the truth behind the new contract, which was hailed as the saviour of NHS dentistry. Despite words of comfort and reassurance from the CDO, the majority of dentists seem ill at ease with their lot. There are mutterings in the ranks; there are concerned whispers about UDA values and 2009. They huddle in their surgeries, worrying about the financial implications of their underperformance. PCTs, short of money are only now being given the data by the BSA about how well their dentists have done. Many are not happy with what they see. This article looks at where we are now, and gives a personal view on how we got here.
Collapse
|
42
|
Abstract
TEM analysis of mesoporous materials is generally undertaken to give qualitative results. Accurate quantitative analysis is demonstrated in this study. A systematic image analysis of a powder form of a hexagonal mesoporous material known as KIT-6 is conducted using a transmission electron microscope (TEM). Three types of image contrast typically appear in this material (a hexagonal honeycomb structure, wide and narrow parallel lines). The honeycomb face is used to characterise this material in terms of a conventional 2-D hexagonal structure and the d-spacings for the (100) and (110) planes are experimentally measured in varying focus conditions. A tilting experiment is conducted to determine how the angle of tilt affects the line spacing and their visibility. Tilting has very little effect on the line spacing, whereas it affects the visibility of both the wide and narrow lines by limiting an angle range of visibility. The hexagonal lattice structure parameter determined by TEM method is found to be approximately 7% lower than that calculated by low-angle X-ray diffraction. Thus we conclude that TEM data can be used to determine the geometry and dimensions of hexagonal mesoporous silica materials, with a small error in the hexagonal lattice parameter.
Collapse
|
43
|
Philosophy in practice. Br Dent J 2005; 199:189. [PMID: 16127384 DOI: 10.1038/sj.bdj.4812661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
44
|
Quality of prescribing: a study of guideline adherence of medication in patients with diabetes mellitus. ACTA ACUST UNITED AC 2005. [DOI: 10.1002/pdi.850] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
45
|
On-site treatment of a motorway service area wastewater using a package sequencing batch reactor (SBR). WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2005; 51:311-6. [PMID: 16104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A sequencing batch reactor (SBR) treating the effluent of a motorway service station in the south of England situated on a major tourist route was investigated. Wastewater from the kitchens, toilets and washrooms facilities was collected from the areas on each side of the motorway for treatment on-site. The SBR was designed for a population equivalent (p.e.) of 500, assuming an average flow of 100 m3/d, influent biochemical oxygen demand (BOD) of 300 mg/l, and influent suspended solids (SS) of 300 mg/l. Influent monitoring over 8 weeks revealed that the average flow was only 65 m3/d and the average influent BOD and SS were 480 mg/l and 473 mg/l respectively. This corresponded to a high sludge loading rate (F:M) of 0.42 d(-1) which accounted for poor performance. Therefore the cycle times were extended from 6 h to 7 h and effluent BOD improved from 79 to 27 mg/l.
Collapse
|
46
|
Abstract
BACKGROUND Dementia is a common mental health problem affecting 5% of those over 65. Various pathological processes are linked to memory impairment in dementia, particularly those affecting the cholinergic neurotransmitter system. Acetyl-l-carnitine (ALC) is derived from carnitine and is described as having several properties which may be beneficial in dementia. This includes activity at cholinergic neurons, membrane stabilization and enhancing mitochondrial function. Work on the effects of ALC has been ongoing since the 1980s yet the efficacy of ALC in cognitive decline remains unclear. Early studies suggested a beneficial effect of ALC on cognition and behaviour in aging subjects. However, later, larger studies have not supported these findings. Some of the difficulties lie in the early and later studies differing widely in methodology and assessment tools used, and are therefore difficult to compare. ALC is not currently in routine clinical use. OBJECTIVES The objective of this review is to establish whether Acetyl-l-carnitine is clinically effective in the treatment of people with dementia. SEARCH STRATEGY The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 8 January 2003 using the terms acetyl-l-carnitine, l-carnitine acetyl ester, acetylcarnitine. SELECTION CRITERIA All double-blind, randomized, trials involving people with dementia in which treatment with ALC was compared with a placebo group DATA COLLECTION AND ANALYSIS Data were extracted by a reviewer (SH) and entered into Revman 4.1 software. Where possible intention-to-treat data were used, but most of the analyses were of completers (people who completed the study). MAIN RESULTS There are 11 included trials, all of which had restricted the participants to people with Alzheimer's disease. All trials assessed the cognitive effects of ALC and in addition six considered severity of dementia, six considered functional ability and six considered clinical global impression. There were statistically significant treatment effects in favour of ALC at 12 and 24 weeks for the numbers showing improvement as determined by Clinical Global Impression, [OR 2.33, 95% CI 1.25 to 4.35, P<0.01] and [OR 3.91, 95% CI 1.32 to 11.54, P=0.01] but not as determined by the CIGIC at 52 weeks. There was no evidence of benefit for ALC in the areas of cognition, severity of dementia, functional ability or Clinical Global Impression as a continuous measure. Various adverse events were reported, but from the meta-analyses there were no statistically significant differences between treated and placebo groups. REVIEWER'S CONCLUSIONS There is evidence for benefit of ALC on clinical global impression, but there was no evidence using objective assessments in any other area of outcome. Given the large number of comparisons made, the statistically significant result may be due to chance. At present there is no evidence to recommend its routine use in clinical practice. Although the intention of the review was to access ALC for the treatment of all dementias, the included trials had confined themselves to participants with Alzheimer's disease. Individual patient data may add to the findings, as would trials including other types of dementia and other outcomes (e.g. mood and caregiver quality of life). However, the evidence does not suggest that ALC is likely to prove an important therapeutic agent. More work on the pharmacokinetics of ALC in humans is also required.
Collapse
|
47
|
Structural characteristics and properties of the regenerated silk fibroin prepared from formic acid. Int J Biol Macromol 2001; 29:91-7. [PMID: 11518580 DOI: 10.1016/s0141-8130(01)00159-3] [Citation(s) in RCA: 265] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Structural characteristics and thermal and solution properties of the regenerated silk fibroin (SF) prepared from formic acid (FU) were compared with those of SF from water (AU). According to the turbidity and shear viscosity measurement, SF formic acid solution was stable and transparent, no molecular aggregations occurred. The sample FU exhibited the beta-sheet structure, while AU random coil conformation using Fourier transform infrared (FTIR), X-ray diffraction (XRD), and differential scanning calorimetry. The effects of methanol treatment on samples were also examined. According to the measurement of crystallinity (XRD) and crystallinity index (FTIR), the concept of long/short-range ordered structure formation was proposed. Long-range ordered crystallites are predominantly formed for methanol treated SF film while SF film cast from formic acid favors the formation of short-range ordered structure. The relaxation temperatures of SF films measured by dynamic thermomechanical analysis supported the above mechanism due to the sensitivity of relaxation temperature on the short-range order.
Collapse
|
48
|
Medication management in the community: some considerations about compliance. HOME CARE PROVIDER 2001; 6:114-5. [PMID: 11496260 DOI: 10.1067/mhc.2001.117493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
49
|
Abstract
OBJECTIVE To explore gender and racial equity in emergency room treatment of chest pain. METHODS Three hundred seventy-nine patient records were analyzed, taking into account effects of age, clinic, comorbid status, and insurance status. RESULTS Analysis of covariance and logistic regression revealed statistically significant differences between races but not between genders for time to first EKG and percent of patients receiving cardiac catheterization and echocardiography. Blacks waited longer than whites for an EKG and were less likely to receive cardiac catheterizations but more likely to receive echocardiography. CONCLUSION This study demonstrates a lack of equity by race in treatment of chest pain emergencies.
Collapse
|
50
|
Specificity of preformed alloantibodies causing B cell positive flow crossmatch in renal transplantation. Clin Transplant 2000; 14:533-42. [PMID: 11127305 DOI: 10.1034/j.1399-0012.2000.140604.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The specificity of alloantibodies (alloAb) and their clinical significance in association with T-/B+ flow cytometry crossmatch (FCXM) in kidney transplantation are not clearly defined. This study was undertaken to examine the HLA specificity and clinical relevance of Ab causing B+ FCXM in pre-transplant (final XM) recipients' serum samples. Final FCXM serum samples were analyzed from 457 renal transplant patients followed for 10 months post-transplantation. Two hundred and sixty patients had T-/B+ final FCXM. The control group included 197 recipients with T-/B- FCXM at time of transplantation. Class I/class II PRA and specificity of anti-HLA class I and class II Ab in final FCXM serum samples were analyzed by FlowPRA Class I Screening Test and FlowPRA Class II Screening Test. We found no correlation between graft outcome and pre-transplant T-/B- and T-/B+ FCXM status. Additionally, we observed no clinical relevance of B+ FCXM in retransplant patients. However, MCS > or =200 in B+ FCXM retransplant recipients was associated with anti-class II Ab to previous mismatches in regrafted patients (n = 46). This finding was confirmed by specificity analysis of anti-DR/DQ Ab in patients with high ( > or =15%) class II PRA. In 63% (12 of 19) of retransplants having T-/B+ FCXM, we defined the specificity of alloAb to first graft mismatched class II antigens. In contrast, anti-class II Ab was detected in only 5.7% (2 of 35) of single-graft recipients with different PRA values. Significantly greater MCS (240 +/- 61 vs. 163 +/- 48; p = 0.022) was observed in retransplant patients having short ( < or =5 m) previous graft survival time (PGST) than in those with long PGST ( > or =5 m). Only 2% of retransplant recipients with B + FCXM had non-HLA Ab. In contrast, the overwhelming majority of primary recipients had no detectable alloAbs. No significant difference in class I PRA was found between B- and B+ FCXM recipients. However, class II PRA was significantly higher in patients having B + FCXM (p = 0.028). Collectively, these data show that MCS intensity is not always a reliable criterion for anti-HLA Ab detection because of the presence of non-HLA Ab. These results can be explained by low titers of anti-class II Ab, at which concentration these Ab cannot produce a deleterious effect. FlowPRA and Flow screen beads appeared to be reliable and sensitive methods for detection and specificity analysis of anti-class II alloAb.
Collapse
|