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https://www.readbyqxmd.com/read/28077205/impact-of-pharmacists-in-optimizing-geriatric-pharmacotherapy-in-primary-care-within-a-veterans-affairs-medical-center
#1
Taryn B Mondiello, Lauren A Stutzman
OBJECTIVE: To assess pharmacists' impact on optimizing pharmacotherapy among geriatric patients. DESIGN: Single-site, prospective, quality-improvement project. SETTING: Primary care at a Veterans Affairs medical center. PARTICIPANTS: Thirteen males 75 years of age and older were included. INTERVENTIONS: Recommendations were made by pharmacists to optimize prescribing. MAIN OUTCOME MEASURES: Differences between specific instances of suboptimal prescribing before and after pharmacists' recommendations, the percentage of pharmacists' recommendations accepted, and the top most commonly prescribed psychotropic medications and their most common indications...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28067776/sensitivity-of-quantitative-signal-detection-in-regards-to-pharmacological-neuroenhancement
#2
Maximilian Gahr, Bernhard J Connemann, Carlos Schönfeldt-Lecuona, René Zeiss
Pharmacological neuroenhancement (PNE) is a form of abuse and has not yet been addressed by methods of pharmacovigilance. In the present study, we tested if quantitative signal detection may be sensitive in regards to PNE. We evaluated the risk of drug abuse and dependence (DAAD) related to substances that are known to be used for PNE and divided this group into agents with (methylphenidate) and without a known abuse potential outside the field of PNE (atomoxetine, modafinil, acetylcholine esterase inhibitors, and memantine)...
January 5, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28067201/false-negative-on-a-proven-involuntary-intoxication-in-two-children-with-lorazepam
#3
Catherine Feliu, Hélène Guillemin, Claire Gozalo, Aurélie Fouley, Hélène Marty, Hervé Millart, Zoubir Djerada
Children aged between 1 to 4 years are the most at risk of unintentional poisonings. Benzodiazepines are the most medicine often cause of the poisoning. Among the twenty-two most prescribed benzodiazepines in France, lorazepam ranks fifth behind zolpidem, alprazolam, bromazepam and zopiclone. However the automated assay currently available does not allow to detect and/or to quantify lorazepam. The alternative to the immunoassay is the liquid chromatography coupled with mass spectrometry (HPLC/MS). This technique, highly sensitive and specific, requires a pre-treatment phase and a good technical proficiency, justifying specialized staff...
January 9, 2017: Annales de Biologie Clinique
https://www.readbyqxmd.com/read/28057897/review-and-update-of-the-hong-kong-epilepsy-guideline-on-status-epilepticus
#4
REVIEW
E Lw Fung, B Bh Fung
Convulsive status epilepticus is the most extreme form of seizure. It is a medical and neurological emergency that requires prompt and appropriate treatment. Treatment of convulsive status epilepticus is usually divided into stages/steps. The International League Against Epilepsy has released a new definition of status epilepticus that may help to unify the definition in future studies. Over the last few years new information has become available regarding its management. The Rapid Anticonvulsant Medication Prior to Arrival Trial demonstrated non-inferiority of intramuscular midazolam in early status epilepticus compared with intravenous lorazepam...
January 6, 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/27993298/making-sense-of-a-negative-clinical-trial-result-a-bayesian-analysis-of-a-clinical-trial-of-lorazepam-and-diazepam-for-pediatric-status-epilepticus
#5
Daniel B Chamberlain, James M Chamberlain
STUDY OBJECTIVE: We demonstrate the application of a Bayesian approach to a recent negative clinical trial result. A Bayesian analysis of such a trial can provide a more useful interpretation of results and can incorporate previous evidence. METHODS: This was a secondary analysis of the efficacy and safety results of the Pediatric Seizure Study, a randomized clinical trial of lorazepam versus diazepam for pediatric status epilepticus. We included the published results from the only prospective pediatric study of status in a Bayesian hierarchic model, and we performed sensitivity analyses on the amount of pooling between studies...
January 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27979642/severe-carisoprodol-withdrawal-after-a-14-year-addiction-and-acute-overdose
#6
Kathy T Vo, Howard Horng, Craig G Smollin, Neal L Benowitz
BACKGROUND: Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has barbiturate-like properties at the GABA-A receptor, leading to central nervous system depression and desired effects. Its tolerance and dependence has been previously demonstrated in an animal model, and withdrawal has been described in several recent case reports. Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic agents. However, abrupt cessation in a patient with a history of long-term and high-dose carisoprodol abuse may result in symptoms that are more difficult for providers to treat...
December 12, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27943220/population-pharmacokinetics-and-exploratory-pharmacodynamics-of-lorazepam-in-pediatric-status-epilepticus
#7
Daniel Gonzalez, James M Chamberlain, Jeffrey T Guptill, Michael Cohen-Wolkowiez, Barrie Harper, Jian Zhao, Edmund V Capparelli
BACKGROUND: Lorazepam is one of the preferred agents used for intravenous treatment of status epilepticus (SE). We combined data from two pediatric clinical trials to characterize the population pharmacokinetics of intravenous lorazepam in infants and children aged 3 months to 17 years with active SE or a history of SE. METHODS: We developed a population pharmacokinetic model for lorazepam using the NONMEM software. We then assessed exploratory exposure-response relationships using the overall efficacy and safety study endpoints, and performed dosing simulations...
December 9, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/27943131/knowledge-and-attitude-towards-pharmacological-management-of-acute-agitation-a-survey-of-psychiatrists-psychiatry-residents-and-psychiatric-nurses
#8
KeumbÔh Tangu, Adaora Ifeanyi, Mayurapriya Velusamy, Sara Dar, Nurun Shah, Ifeoma E Ezeobele, Olaoluwa O Okusaga
OBJECTIVE: The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. METHODS: Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital...
December 9, 2016: Academic Psychiatry
https://www.readbyqxmd.com/read/27942054/effect-of-melatonin-on-duration-of-delirium-in-organophosphorus-compound-poisoning-patients-a-double-blind-randomised-placebo-controlled-trial
#9
H N Vijayakumar, K Ramya, Devika Rani Duggappa, Km Veeranna Gowda, K Sudheesh, S S Nethra, R S Raghavendra Rao
BACKGROUND AND AIMS: Organophosphate compound poisoning (OPCP) is associated with high incidence of delirium. Melatonin has been tried in the treatment of delirium and has shown a beneficial effect in OPCP. This study was conducted to know the effect of melatonin on duration of delirium and recovery profile in OPCP patients. METHODS: Double-blind randomised placebo control trial in which 56 patients of OPCP confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged >18 years and weighing between 50 and 100 kg, and Acute Physiology and Chronic Health Evaluation II score of <20 were studied...
November 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27928709/the-gabaergic-system-in-prefrontal-cortex-and-hippocampus-modulates-context-related-extinction-learning-and-renewal-in-humans
#10
Silke Lissek, Anne Golisch, Benjamin Glaubitz, Martin Tegenthoff
Context-related extinction learning and renewal in humans is mediated by hippocampal and prefrontal regions. Renewal is defined as the reoccurrence of an extinguished response if the contexts present during extinction learning and recall differ. Animal studies implicate hippocampal γ-aminobutyric acid (GABA) A receptors in extinction and renewal. However, human studies on GABAergic mechanisms in extinction learning are lacking. In this fMRI study, we therefore investigated the role of the GABAergic system in context-related extinction learning and renewal...
December 7, 2016: Brain Imaging and Behavior
https://www.readbyqxmd.com/read/27911381/a-novel-approach-for-the-administration-of-medications-and-fluids-in-emergency-scenarios-and-settings
#11
Akilesh Honasoge, Neal Lyons, Kathleen Hesse, Braden Parker, Robert Mokszycki, Kelly Wesselhoff, Rolla Sweis, Erik B Kulstad
The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption)...
November 9, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/27890824/evaluating-a-switch-from-meconium-to-umbilical-cord-tissue-for-newborn-drug-testing-a-retrospective-study-at-an-academic-medical-center
#12
Kendra L Palmer, Kelly E Wood, Matthew D Krasowski
BACKGROUND: The objective of this study was to compare detection rates of newborn drug exposure at an academic medical center transitioning from meconium to umbilical cord tissue toxicology testing. METHODS: We performed an Institutional Review Board-approved retrospective chart review on all newborns (n=2072) for whom newborn drug testing was ordered at our academic medical center between June 2012 and August 2015 (in August 2013, umbilical cord tissue became the preferred specimen)...
November 24, 2016: Clinical Biochemistry
https://www.readbyqxmd.com/read/27890484/25-years-of-advances-in-definition-classification-and-treatment-of-status-epilepticus
#13
Eugen Trinka, Reetta Kälviäinen
PURPOSE: Status epilepticus (SE) requires not only urgent symptomatic treatment with antiepileptic drugs but also rapid identification and treatment of its cause. This narrative review summarizes the most important advances in classification and treatment of SE. METHOD: Data sources included MEDLINE, EMBASE, ClinicalTrials.gov, and back tracking of references in pertinent studies, reviews, and books. RESULTS: SE is now defined as "a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1)...
November 14, 2016: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/27885664/haloperidol-plus-promethazine-for-psychosis-induced-aggression
#14
REVIEW
Gisele Huf, Jacob Alexander, Pinky Gandhi, Michael H Allen
BACKGROUND: Health services often manage agitated or violent people, and such behaviour is particularly prevalent in emergency psychiatric services (10%). The drugs used in such situations should ensure that the person becomes calm swiftly and safely. OBJECTIVES: To examine whether haloperidol plus promethazine is an effective treatment for psychosis-induced aggression. SEARCH METHODS: On 6 May 2015 we searched the Cochrane Schizophrenia Group's Register of Trials, which is compiled by systematic searches of major resources (including MEDLINE, EMBASE, AMED, BIOSIS, CINAHL, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings...
25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27881622/stability-of-21-cocaine-opioid-and-benzodiazepine-drug-analytes-in-spiked-meconium-at-three-temperatures
#15
Fang Wu, Stephanie J Marin, Gwendolyn A McMillin
In this study, the stability of 21 cocaine, opioid and benzodiazepine analytes in spiked meconium was investigated at three storage temperatures: 4°C, room temperature (RT), and 37°C (body temperature). The drugs/metabolites included were hydrocodone, hydromorphone, codeine, morphine, 6-acetylmorphine (6-AM), oxycodone, oxymorphone, cocaine, cocaethylene, benzoylecgonine, m-hydroxybenzoylecgonine, diazepam, oxazepam, temazepam, nordiazepam, chlordiazepoxide, lorazepam, alprazolam, alpha-hydroxyalprazolam, clonazepam, 7-aminoclonazepam, midazolam, alpha-hydroxymidazolam and zolpidem...
November 22, 2016: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/27879296/elevated-modified-shock-index-within-24-hours-of-icu-admission-is-an-early-indicator-of-mortality-in-the-critically-ill
#16
Nathan J Smischney, Mohamed O Seisa, Katherine J Heise, Darrell R Schroeder, Timothy J Weister, Daniel A Diedrich
PURPOSE: To assess whether exposure to modified shock index (MSI) in the first 24 hours of intensive care unit (ICU) admission is associated with increased in-hospital mortality. METHODS: Adult critically ill patients were included in a case-control design with 1:2 matching. Cases (death) and controls (alive) were abstracted by a reviewer blinded to exposure status (MSI). Cases were matched to controls on 3 factors-age, end-stage renal disease, and ICU admission diagnosis...
November 21, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27866243/monitoring-of-adherence-to-headache-treatments-by-means-of-hair-analysis
#17
Anna Ferrari, Manuela Licata, Cecilia Rustichelli, Carlo Baraldi, Daniele Vandelli, Filippo Marchesi, Federica Palazzoli, Patrizia Verri, Enrico Silingardi
PURPOSE: The aim of this study was to evaluate the potential of hair analysis to monitor medication adherence in headache patients undergoing chronic therapy. For this purpose, the following parameters were analyzed: the detection rate of 23 therapeutic drugs in headache patients' hair, the degree of agreement between the self-reported drug and the drug found in hair, and whether the levels found in hair reflected the drug intake reported by the patients. METHODS: The study included 93 patients suffering from primary headaches declaring their daily intake of at least one of the following drugs during the 3 months before the hair sampling: alprazolam, amitriptyline, citalopram, clomipramine, clonazepam, delorazepam, diazepam, duloxetine, fluoxetine, flurazepam, levomepromazine, levosulpiride, lorazepam, lormetazepam, mirtazapine, paroxetine, quetiapine, sertraline, topiramate, trazodone, triazolam, venlafaxine, and zolpidem...
November 20, 2016: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27827989/activated-carbon-based-system-for-the-disposal-of-psychoactive-medications
#18
Yang Song, Mahima Manian, William Fowler, Andrew Korey, Ajay Kumar Banga
The misuse and improper disposal of psychoactive medications is a major safety and environmental concern. Hence, the proper disposal of these medications is critically important. A drug deactivation system which contains activated carbon offers a unique disposal method. In the present study, deactivation efficiency of this system was tested by using three model psychoactive drugs. HPLC validation was performed for each drug to ensure that the analytical method employed was suitable for its intended use. The method was found to be specific, accurate and precise for analyzing the drugs...
November 7, 2016: Pharmaceutics
https://www.readbyqxmd.com/read/27775683/-hospital-emergencies-associated-with-the-consumption-of-hypnotics-and-sedatives-2009-2013-castilla-y-le%C3%A3-n-spain
#19
Verónica Rubio González, Susana Redondo Martín, Gema Ruíz López Del Prado, Mª Fe Muñoz Moreno, Alexander Velázquez Miranda
OBJECTIVE: Household Survey on Alcohol and Other Drugs shows the progressive increase in the consumption of hypnotics, alone or in combination with other substances. The aim of the research was to obtain information about the consumption of hypnotics and sedatives in population of Castilla y León treated in emergency medical services of four monitored hospitals between 2009-2013, describing clinical and epidemiological characteristics of the emergencies and what drugs were consumed, to provide information for future interventions...
October 24, 2016: Revista Española de Salud Pública
https://www.readbyqxmd.com/read/27752878/treatment-of-rem-sleep-behavior-disorder
#20
Youngsin Jung, Erik K St Louis
REM sleep behavior disorder (RBD) is a common parasomnia disorder affecting between 1 and 7 % of community-dwelling adults, most frequently older adults. RBD is characterized by nocturnal complex motor behavior and polysomnographic REM sleep without atonia. RBD is strongly associated with synucleinopathy neurodegeneration. The approach to RBD management is currently twofold: symptomatic treatment to prevent injury and prognostic counseling and longitudinal follow-up surveillance for phenoconversion toward overt neurodegenerative disorders...
November 2016: Current Treatment Options in Neurology
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