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https://www.readbyqxmd.com/read/29667859/prescribing-naloxone-for-opioid-overdose-intervention
#1
Robert B Dunne
To provide an update on prescription of naloxone as a harm-reduction strategy, PubMed was searched to identify publications relevant to naloxone prescribing for reversal of opioid overdose. Opportunities now exist to expand naloxone use, although evidence suggests these are often missed or underexploited. The US FDA has approved an intranasal naloxone spray and an autoinjector naloxone formulation for community use. Effective use of naloxone in community settings requires screening to identify patients at risk of opioid overdose, discussing naloxone use with patients and their relatives, and providing appropriate training...
April 18, 2018: Pain Management
https://www.readbyqxmd.com/read/29667452/the-feasibility-of-employing-a-home-healthcare-model-for-education-and-treatment-of-opioid-overdose-using-a-naloxone-auto-injector-in-a-private-practice-pain-medicine-clinic
#2
Anthony Dragovich, Fred Brason, Thomas Beltran, Amy McCoart, Anthony R Plunkett
OBJECTIVES: The purpose of this study was to determine if employing a home healthcare model for education and treatment of opioid overdose using Evzio® (Naloxone)* auto-injector in a private practice pain clinic. METHODS: A prospective survey was used to determine the feasibility of integrating a naloxone auto-injector within the patient's home with a home care training model. Twenty moderate or high-risk patients were enrolled from our chronic pain clinic. Patients who were moderate or high risk completed an evaluation survey...
April 18, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29667370/systems-toxicology-approach-to-identifying-paracetamol-overdose
#3
Chantelle L Mason, Joseph Leedale, Sotiris Tasoulis, Ian Jarman, Daniel J Antoine, Steven D Webb
Paracetamol (acetaminophen (APAP)) is one of the most commonly used analgesics in the United Kingdom and the United States. However, exceeding the maximum recommended dose can cause serious liver injury and even death. Promising APAP toxicity biomarkers are thought to add value to those used currently and clarification of the functional relationships between these biomarkers and liver injury would aid clinical implementation of an improved APAP toxicity identification framework. The framework currently used to define an APAP overdose is highly dependent upon time since ingestion and initial dose; information that is often highly unpredictable...
April 18, 2018: CPT: Pharmacometrics & Systems Pharmacology
https://www.readbyqxmd.com/read/29666565/postnatal-vitamin-d-intake-modulates-hippocampal-learning-and-memory-in-adult-mice
#4
Qiujuan Liang, Chunhui Cai, Dongxia Duan, Xinyu Hu, Wanhao Hua, Peicheng Jiang, Liu Zhang, Jun Xu, Zhengliang Gao
Vitamin D (VD) is a neuroactive steroid crucial for brain development, function and homeostasis. Its deficiency is associated with numerous brain conditions. As such, VD and its variants are routinely taken by a broad of groups with/without known VD deficiency. In contrast, the harmful effects of VD overdose have been poorly studied. Similarly, the developmental stage-specific VD deficiency and overdose have been rarely explored. In the present work, we showed that postnatal VD supplementation enhanced the motor function transiently in the young adult, but not in the older one...
2018: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29661774/accuracy-safety-and-reliability-of-novel-phase-i-trial-designs
#5
Heng Zhou, Ying Yuan, Lei Nie
A number of novel model-based and model-assisted designs have been proposed to find the maximum tolerated dose (MTD) in phase I clinical trials, but their differences and relative pros and cons are not clear to many practitioners. We review three model-based designs, including the continual reassessment method (CRM), dose escalation with overdose control (EWOC), and Bayesian logistic regression model (BLRM), and three model-assisted designs, including the modified toxicity probability interval (mTPI), Bayesian optimal interval (BOIN), and keyboard designs...
April 16, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/29661409/anticoagulant-and-side-effects-of-protamine-in-cardiac-surgery-a-narrative-review
#6
REVIEW
C Boer, M I Meesters, D Veerhoek, A B A Vonk
Neutralisation of systemic anticoagulation with heparin in cardiac surgery with cardiopulmonary bypass requires protamine administration. If adequately dosed, protamine neutralises heparin and reduces the risk of postoperative bleeding. However, as its anticoagulant properties are particularly exerted in the absence of heparin, overdosing of protamine may contribute to bleeding and increased transfusion requirements. This narrative review describes the mechanisms underlying the anticoagulant properties and side-effects of protamine, and the impact of protamine dosing on the activated clotting time and point-of-care viscoelastic test results, and explains the distinct protamine dosing strategies in relation to haemostatic activation and postoperative bleeding...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29660732/safe-and-unsafe-spaces-non-fatal-overdose-arrest-and-receptive-syringe-sharing-among-people-who-inject-drugs-in-public-and-semi-public-spaces-in-baltimore-city
#7
Kyle Hunter, Ju Nyeong Park, Sean T Allen, Patrick Chaulk, Taeko Frost, Brian W Weir, Susan G Sherman
The spaces in which drug use occurs constitutes a key aspect of the "risk environment" of people who inject drugs (PWID). We aimed to add nuance to the characterization of "safe" and "unsafe" spaces in PWID's environments to further understand how these spaces amplify the risk of morbidities associated with injection drug use. PWID were recruited through the Baltimore City syringe service program and through peer referral. Participants completed a socio-behavioral survey. Multivariable logistic regression was used to identify associations between utilization of public, semi-public and private spaces with arrest, non-fatal overdose, and receptive syringe sharing...
April 13, 2018: International Journal on Drug Policy
https://www.readbyqxmd.com/read/29659320/opioid-discussion-in-the-twittersphere
#8
Rachel L Graves, Christopher Tufts, Zachary F Meisel, Dan Polsky, Lyle Ungar, Raina M Merchant
BACKGROUND: The rise in opioid use and overdose has increased the importance of improving data collection methods for the purpose of targeting resources to high-need populations and responding rapidly to emerging trends. OBJECTIVE: To determine whether Twitter data could be used to identify geographic differences in opioid-related discussion and whether opioid topics were significantly correlated with opioid overdose death rate. METHODS: We filtered approximately 10 billion tweets for keywords related to opioids between July 2009 and October 2015...
April 16, 2018: Substance Use & Misuse
https://www.readbyqxmd.com/read/29657737/flunitrazepam-overdose-induces-brilliant-blue-gastric-fluid
#9
Toshinobu Yamagishi, Akiko Akashi, Hiroshi Shimizu, Takuto Ishida, Takahiro Tanabe, Kazuhiro Sugiyama, Yuichi Hamabe
No abstract text is available yet for this article.
April 2018: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29657697/characterizing-mortality-from-substance-abuse-in-iran-an-epidemiological-study-during-march-2014-to-february-2015
#10
Fatemeh Shahbazi, Seyed Davood Mirtorabi, Mohammad Reza Ghadirzadeh, Seyed Saeed Hashemi-Nazari, Abdolrazagh Barzegar
Background: Drug abuse is a severe and chronic disorder that leaves morbidity, disability and premature mortality in the society. The study of death due to substance abuse provides useful information for local, national and international administrators. Thus, by identifying the factors that have an impact on overdose-related mortality we can provide suitable intervention for vulnerable groups. The aim of this study was an investigation of mortality rate caused by consumption of narcotic and psychoactive substances in Iran...
July 2017: Addiction & Health
https://www.readbyqxmd.com/read/29656805/multiple-opioid-prescriptions-among-privately-insured-dental-patients-in-the-united-states-evidence-from-claims-data
#11
Niodita Gupta, Marko Vujicic, Andrew Blatz
BACKGROUND: Multiple or high dosage opioid prescriptions increase the risk of experiencing drug misuse and overdose. The authors examine index (first) and follow-up opioid prescriptions for 1 year among privately insured dental patients in the United States from 2010 through 2015. METHODS: The authors used the 2010 through 2015 Truven Health MarketScan Research databases and the Prescription Drug Monitoring Program Training Technical Assistance Center conversion data set...
April 12, 2018: Journal of the American Dental Association
https://www.readbyqxmd.com/read/29652682/kratom-an-emerging-drug-of-abuse-a-case-report-of-overdose-and-management-of-withdrawal
#12
Jack Diep, David Tian Chin, Somdatta Gupta, Faraz Syed, Ming Xiong, Jianguo Cheng
Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens...
April 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29650444/reviewing-state-mandated-training-requirements-for-naloxone-dispensing-pharmacists
#13
Andrew W Roberts, Delesha M Carpenter, Austin Smith, Kevin A Look
BACKGROUND: Expanding access to naloxone is crucial for mitigating the public health epidemic of opioid overdose deaths in America. Pharmacists now have greater independent authority to dispense naloxone to the public due to a wave of enhanced pharmacy naloxone access laws. It is unknown to what extent pharmacists are required to receive specialized training to serve in this capacity. OBJECTIVES: The goal of this study was to review naloxone training mandates from states with enhanced pharmacy naloxone access laws...
April 5, 2018: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29649094/methadone-maintenance-treatment-a-15-year-retrospective-study-in-split-dalmatia-county-croatia
#14
Davorka Sutlovic, Zeljko Kljucevic, Livia Sliskovic, Helena Susnjar, Ivo Viskovic, Marija Definis-Gojanovic
BACKGROUND: The aim of this retrospective study is to use existing epidemiological data on patients in methadone maintenance treatment in Split Dalmatia County from 2001 to 2015 in order to evaluate the substitution treatment system and policy of opiate addicts treatment, the epidemiological trend, and risk of overdose mortality. In addition, we would like to highlight the problem of poor control of methadone therapy, and thus the possibility of selling methadone. The result is a greater number of deaths caused by methadone in people who were not in methadone therapy...
April 11, 2018: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/29628888/licochalcone-a-upregulates-nrf2-antioxidant-pathway-and-thereby-alleviates-acetaminophen-induced-hepatotoxicity
#15
Hongming Lv, Qingfei Xiao, Junfeng Zhou, Haihua Feng, Guowen Liu, Xinxin Ci
Acetaminophen (APAP) overdose-induced fatal hepatotoxicity is majorly characterized by overwhelmingly increased oxidative stress while enhanced nuclear factor-erythroid 2-related factor 2 (Nrf2) is involved in prevention of hepatotoxicity. Although Licochalcone A (Lico A) upregulates Nrf2 signaling pathway against oxidative stress-triggered cell injury, whether it could protect from APAP-induced hepatotoxicity by directly inducing Nrf2 activation is still poorly elucidated. This study aims to explore the protective effect of Lico A against APAP-induced hepatotoxicity and its underlying molecular mechanisms...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29628190/prognostic-utility-of-initial-lactate-in-patients-with-acute-drug-overdose-a-validation-cohort
#16
Randy Cheung, Robert S Hoffman, David Vlahov, Alex F Manini
STUDY OBJECTIVE: Previous studies have suggested that the initial emergency department (ED) lactate concentration may be an important prognostic indicator for inhospital mortality from acute drug poisoning. We conduct this cohort study to formally validate the prognostic utility of the initial lactate concentration in a larger, distinct patient population with acute drug overdose. METHODS: This observational, prospective, cohort study was conducted during 5 years at 2 urban teaching hospitals...
April 6, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29627712/accurate-identification-of-opioid-overdose-deaths-using-coronial-data
#17
Amanda Roxburgh, Jennifer L Pilgrim, Wayne D Hall, Lucinda Burns, Louisa Degenhardt
INTRODUCTION: Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data. MATERIALS AND METHODS: The National Coronial Information System (NCIS), an online coronial database containing information on all deaths that are reported to a coroner in Australia, is used to develop methods to more accurately identify opioid overdose deaths...
March 26, 2018: Forensic Science International
https://www.readbyqxmd.com/read/29626743/examining-racial-ethnic-differences-in-patterns-of-benzodiazepine-prescription-and-misuse
#18
Benjamin Cook, Timothy Creedon, Ye Wang, Chunling Lu, Nicholas Carson, Piter Jules, Esther Lee, Margarita Alegría
BACKGROUND: Benzodiazepines (BZDs) are widely prescribed during psychiatric treatment. Unfortunately, their misuse has led to recent surges in overdose emergency visits and drug-related deaths. METHODS: Electronic health record data from a large healthcare system were used to describe racial/ethnic, sex, and age differences in BZD use and dependence. Among patients with a BZD prescription, we assessed differences in the likelihood of subsequently receiving a BZD dependence diagnosis, number of BZD prescriptions, receiving only one BZD prescription, and receiving 18 or more BZD prescriptions...
March 26, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29625751/naloxone-formulation-for-overdose-reversal-preference-among-patients-receiving-opioids-for-pain-management
#19
Kelly E Dunn, Frederick S Barrett, George E Bigelow
BACKGROUND: Opioid-related overdose has increased 137% in the past decade. Training nonmedical bystanders to administer naloxone (Narcan™) is a widely-researched intervention that has been associated with decreases in overdose rates in the communities in which it has been implemented. A recent review advocated for noninjectable formulations of naloxone, however patient preference for naloxone formulations has not yet been examined (Strang et al., 2016). METHODS: Two cohorts of respondents (N1  = 501, N2  = 172) who reported currently being prescribed an opioid for pain management were recruited through the crowd-sourcing program Amazon Mechanical Turk (MTurk) to assess their preference for naloxone formulations...
March 28, 2018: Addictive Behaviors
https://www.readbyqxmd.com/read/29625621/expanding-harm-reduction-to-include-fentanyl-urine-testing-results-from-a-pilot-in-rural-british-columbia
#20
Silvina C Mema, Chloe Sage, Serge Popoff, Jessica Bridgeman, Deanne Taylor, Trevor Corneil
BACKGROUND: Harm reduction has been at the forefront of the response to the opioid overdose public health emergency in British Columbia (BC). The unprecedented number of opioid overdose deaths in the province calls for an expansion of harm reduction services. The purpose of this study was to determine the acceptability of a fentanyl urine drug test among people who use drugs (PWUD) and explore whether testing introduced any changes in participants' attitudes and behaviors towards their drug use...
April 6, 2018: Harm Reduction Journal
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