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https://www.readbyqxmd.com/read/28719884/increases-from-2002-to-2015-in-prescription-opioid-overdose-deaths-in-combination-with-other-substances
#1
Denise B Kandel, Mei-Chen Hu, Pamela Griesler, Melanie Wall
BACKGROUND: Prescription opioid (PO) overdose deaths increased sharply over the last decade. Changes in PO deaths in combination with other psychoactive substances may provide a partial explanation. METHODS: PO deaths from the National Multiple-Cause-of-Death Files for 2002-03 (N=15,973) and 2014-15 (N=41,491) were analyzed. We calculated (1) changes in proportions of deaths in combination with benzodiazepines, antidepressants, heroin, alcohol, cocaine between the two periods, and (2) proportions of increase in deaths attributable to each substance among PO and synthetic opioids other than methadone (SO-M) deaths, by age, gender, race/ethnicity...
July 4, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28719481/opioid-prescribing-practices-in-pediatric-acute-care-settings
#2
Michelle DePhillips, Jennifer Watts, Jennifer Lowry, M Denise Dowd
OBJECTIVES: Deaths due to prescription opioid overdoses are at record-high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy. The purpose of this study was to describe the opioid prescribing practices in the emergency departments and urgent care sites of a Midwestern tertiary care children's hospital system. METHODS: This retrospective medical record review examined the visits from the 2 pediatric emergency departments and 2 pediatric urgent care sites in the system from June 1, 2012, to May 31, 2013, during which an outpatient opioid prescription was written...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28719096/the-effect-of-state-laws-designed-to-prevent-nonmedical-prescription-opioid-use-on-overdose-deaths-and-treatment
#3
Ioana Popovici, Johanna Catherine Maclean, Bushra Hijazi, Sharmini Radakrishnan
Nonmedical use of prescription opioids has reached epidemic levels in the United States and globally. In response, federal, state, and local governments are taking actions to address substantial increases in prescription opioid addiction and its associated harms. This study examines the effect of two state laws specifically designed to curtail access to prescription opioids to nonmedical users: pain management clinic and doctor shopping laws. We use administrative data on overdose deaths and admissions to specialty substance use disorder treatment coupled with a differences-in-differences design...
July 18, 2017: Health Economics
https://www.readbyqxmd.com/read/28718908/death-from-butane-inhalation-abuse-in-teenagers-two-new-case-studies-and-review-of-the-literature
#4
Véronique Alunni, Yvan Gaillard, François Castier, Marie-Dominique Piercecchi-Marti, Gérald Quatrehomme
The ready availability of butane makes butane abuse frequent. Fatalities are rare. This study presents two cases of death by butane overdose. The postmortem analyses were carried out using headspace gas chromatography-mass spectrometry. It revealed femoral blood butane concentrations of 18 and 22 mg/L, respectively, as well as specific combinations of adjuvants in each victim. In one of the victims, brain and fatty tissue also contained butane, pointing to chronic consumption. The originality of this study is to show that the identification of specific combinations of adjuvants can be helpful for identifying the brand of deodorant used...
July 18, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28716517/lethal-suicide-attempt-with-a-mixed-drug-intoxication-of-metoprolol-and-propafenone-a-first-pediatric-case-report
#5
Ivana Kacirova, Milan Grundmann, Martin Kolek, Erika Vyskocilova-Hrudikova, Romana Urinovska, Petr Handlos
INTRODUCTION: The β1 adrenergic receptor blocker metoprolol is often prescribed together with the antiarrhythmic drug propafenone. Both are metabolized by cytochrome P450 2D6 and propafenone is also an inhibitor of this enzyme. We present a pediatric case showing metoprolol and propafenone intoxication in combination. CASE: A 14-year-old girl was admitted to a local emergency department after ingestion of metoprolol (probably 1g) and propafenone (probably 1.5-3g) in a suicide attempt...
June 29, 2017: Forensic Science International
https://www.readbyqxmd.com/read/28714199/the-effect-of-dopaminergic-medication-on-conflict-adaptation-in-parkinson-s-disease
#6
Marit F L Ruitenberg, Elger L Abrahamse, Patrick Santens, Wim Notebaert
Parkinson's disease (PD) is a neurological disorder associated primarily with motor symptoms such as tremor, slowness of movement, and difficulties with gait and balance. Most patients take dopaminergic medication to improve their motor functions. Previous studies reported indications that such medication can impair higher cognitive functions (cf. dopamine overdose hypothesis). In the present study, we examined the effect of medication status on conflict adaptation. PD patients performed a Stroop task in which we manipulated the proportion of congruent and incongruent items, thereby allowing us to explore conflict adaptation...
July 16, 2017: Journal of Neuropsychology
https://www.readbyqxmd.com/read/28713798/incidence-and-severity-of-prescribing-errors-in-parenteral-nutrition-for-pediatric-inpatients-at-a-neonatal-and-pediatric-intensive-care-unit
#7
Theresa Hermanspann, Mark Schoberer, Eva Robel-Tillig, Christoph Härtel, Rangmar Goelz, Thorsten Orlikowsky, Albrecht Eisert
OBJECTIVES: Pediatric inpatients are particularly vulnerable to medication errors (MEs), especially in highly individualized preparations like parenteral nutrition (PN). Aside from prescribing via a computerized physician order entry system (CPOE), we evaluated the effect of cross-checking by a clinical pharmacist to prevent harm from PN order errors in a neonatal and pediatric intensive care unit (NICU/PICU). METHODS: The incidence of prescribing errors in PN in a tertiary level NICU/PICU was surveyed prospectively between March 2012 and July 2013 (n = 3,012 orders)...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28712878/antidepressants-are-cytotoxic-to-rat-primary-blood-brain-barrier-endothelial-cells-at-high-therapeutic-concentrations
#8
Ekramy Elmorsy, Ayat Al-Ghafari, Fahd M Almutairi, Amal Misbah Aggour, Wayne G Carter
Antidepressants are commonly employed for the treatment of major depressive disorders and other psychiatric conditions. We investigated the relatively acute cytotoxic effects of three commonly prescribed antidepressants: fluoxetine, sertraline, and clomipramine on rat primary blood brain barrier endothelial cells over a concentration range of 0.1-100μM. At therapeutic concentrations (0.1μM) no significant cytotoxicity was observed after 4, 24, or 48h. At high therapeutic to overdose concentrations (1-100μM), antidepressants reduced cell viability in proportion to their concentration and exposure duration...
July 13, 2017: Toxicology in Vitro: An International Journal Published in Association with BIBRA
https://www.readbyqxmd.com/read/28711751/the-conversion-ratio-from-intravenous-hydromorphone-to-oral-opioids-in-cancer-patients
#9
Akhila Reddy, Marieberta Vidal, Saneese Stephen, Karen Baumgartner, Sara Dost, Ann Nguyen, Yvonne Heung, Simeon Kwan, Angelique Wong, Imelda Pangemanan, Ahsan Azhar, Supakarn Tayjasanant, Edenmae Rodriguez, Jessica Waletich, Kyu-Hyoung Lim, Jimin Wu, Diane Liu, Janet Williams, Sriram Yennurajalingam, Eduardo Bruera
BACKGROUND: The lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily dose (MEDD) may lead to poorly controlled pain or overdosing in cancer inpatients. We aimed to determine the CR and ORR from IV hydromorphone to oral hydromorphone and MEDD (obtained from oral morphine and oxycodone). METHODS: 4745 consecutive inpatient palliative care consults during 2010-14 were reviewed for conversions from IV hydromorphone to oral hydromorphone, morphine or oxycodone...
July 12, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28711132/additional-conditions-amenable-to-observation-care
#10
REVIEW
Matthew A Wheatley
ED observation units (EDOUs) are designed for patients who require diagnostics or therapeutics beyond the initial ED visit to determine the need for hospital admission. Best evidence is that this care be delivered via ordersets or protocols. Occasionally, patients present with conditions that are amenable to EDOU care but fall outside the commonly used protocols. This article details a few of these conditions: abnormal uterine bleeding, allergic reaction, alcohol intoxication, acetaminophen overdose and sickle cell vaso-occlusive crisis...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28710190/stigma-kills-the-psychological-effects-of-emotional-abuse-and-discrimination-towards-a-patient-with-hiv-in-uganda
#11
Simon Ruffell
Our patient is a 58-year-old Ugandan woman. After her husband's death in 1994, the patient was forced to leave her home by her late husband's family and arrangements were made for her mother to provide care until her inevitable death. The patient suffered from multiple mental health disturbances as a result of discrimination. Socially isolated after years of self-neglect, she prepared to overdose. In 2007, she became open regarding her status after receiving psychosocial support from various sources. She opened her home as an HIV clinic with the help of a local doctor, and subsequently the majority of her psychological symptoms were resolved...
July 14, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28710111/managing-an-intentional-overdose-in-a-hospice
#12
Toby Dinnen, Hannah Armstrong, Paul Perkins
This case report describes a patient admitted unconscious to a hospice following an intentional overdose of oxycodone. She had previously declined conventional medical treatment for cancer and had made an advance decision stating that she wished to avoid hospital admission and refusing life-prolonging treatment. This case illustrates the practical and ethical challenges of managing an intentional overdose in a palliative care setting.
July 14, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28709467/amitriptyline-induced-ventricular-tachycardia-a-case-report
#13
Khandker Mohammad Nurus Sabah, Abdul Wadud Chowdhury, Mohammad Shahidul Islam, Bishnu Pada Saha, Syed Rezwan Kabir, Shamima Kawser
BACKGROUND: In Bangladesh, each emergency physician faces amitriptyline overdose nearly a day. An acute cardiovascular complication, one of the worst complications is mainly responsible for the mortality in tricyclic overdose. Recently, we managed ventricular tachycardia in a young female presented with an impaired consciousness 10 h after intentionally ingesting 2500 mg amitriptyline. Here, we report it, discuss how the electrocardiography is vital to acknowledge and predict it and its' complications and also the recent update of the management of it...
July 14, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28708699/flumazenil-for-mixed-drug-overdose
#14
Rukma Parthvi, Sunil Mehra
No abstract text is available yet for this article.
July 6, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/28708603/monte-carlo-skin-dose-simulation-in-intraoperative-radiotherapy-of-breast-cancer-using-spherical-applicators
#15
Farhad Moradi, Ngie Min Ung, M U Khandaker, Ghafour Amouzad Mahdiraji, Marniza Saad, Rozita Abdul Malik, Anita Zarina Bustam, Zainor Zaili, David A Bradley
The relatively new treatment modality electronic intraoperative radiotherapy (IORT) is gaining popularity, irradiation being obtained within a surgically produced cavity being delivered via a low-energy X-ray source and spherical applicators, primarily for early stage breast cancer. Due to the spatially dramatic dose-rate fall off with radial distance from the source and effects related to changes in the beam quality of the low keV photon spectra, dosimetric account of the Intrabeam system is rather complex...
July 14, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28707421/safer-and-more-appropriate-opioid-prescribing-a-large-healthcare-system-s-comprehensive-approach
#16
Jan L Losby, Joel D Hyatt, Michael H Kanter, Grant Baldwin, Denis Matsuoka
RATIONALE, AIMS, AND OBJECTIVES: The United States is in the midst of a public health epidemic with more than 40 people dying each day from prescription opioid overdoses. Health care systems are taking steps to address the opioid overdose epidemic by implementing policy and practice interventions to mitigate the risks of long-term opioid therapy. Kaiser Permanente Southern California launched a comprehensive initiative to transform the way that chronic pain is viewed and treated. Kaiser Permanente Southern California created prescribing and dispensing policies, monitoring and follow-up processes, and clinical coordination through electronic health record integration...
July 14, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28705745/massive-diltiazem-and-metoprolol-overdose-rescued-with-extracorporeal-life-support
#17
James A Chenoweth, Daniel K Colby, Mark E Sutter, Joshua B Radke, Jonathan B Ford, J Nilas Young, John R Richards
The management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion...
July 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28694146/can-causality-assessment-fulfill-the-new-european-definition-of-adverse-drug-reaction-a-review-of-methods-used-in-spontaneous-reporting
#18
REVIEW
Annamaria Mascolo, Cristina Scavone, Maurizio Sessa, Gabriella di Mauro, Daniela Cimmaruta, Valentina Orlando, Francesco Rossi, Liberata Sportiello, Annalisa Capuano
Causality assessment is a fundamental biomedical technique for the signal detection performed by Pharmacovigilance centres in a Spontaneous reporting system. Moreover, it is a crucial and important practice for detecting preventable adverse drug reactions. Among different methods for causality assessment, algorithms (such as the Naranjo, or Begaud Methods) seem for their operational procedure and easier applicability one of the most commonly used methods With the upcoming of the new European Pharmacovigilance legislation including in the definition of the adverse event also effects resulting from abuse, misuse and medication error, all well-known preventable causes of ADRs, there was an emerging need to evaluate whether algorithms could fulfill this new definition...
July 7, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28693650/assessing-efficacy-of-lipid-in-unstable-non-last-overdose-patients
#19
Guy Weinberg
No abstract text is available yet for this article.
July 11, 2017: CJEM
https://www.readbyqxmd.com/read/28692945/impact-of-new-york-prescription-drug-monitoring-program-i-stop-on-statewide-overdose-morbidity
#20
Richard Brown, Moira R Riley, Lydia Ulrich, Ellen Percy Kraly, Paul Jenkins, Nicole L Krupa, Anne Gadomski
BACKGROUND: Prescription Drug Monitoring programs (PDMPs) are intended to reduce opioid prescribing and aberrant drug-related behavior thereby reducing morbidity and mortality due to prescription opioid overdose. Expansion of the New York (NY) State's PDMP in 2013 included the institution of the I-STOP law that mandated clinicians to consult the statewide PDMP database to review the patient's prescription history prior to prescribing opioids. METHODS: Trends in prescription opioid distribution, prescribing, and prescription opioid and heroin overdose morbidity in NY were analyzed using time series...
June 23, 2017: Drug and Alcohol Dependence
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