Search

Background: To combat the opioid crisis, interventions targeting the opioid prescribing behaviour of physicians involved in the management of patients with chronic non-cancer pain (CNCP) have been introduced in clinical settings. An integrative synthesis of systematic review evidence is required to better understand the effects of these interventions. Our objective was to synthesize the systematic review evidence on the effect of interventions targeting the behaviours of physician opioid prescribers for CNCP among adults on patient and population health and prescriber behaviour., Methods: We searched MEDLINE, Embase, and PsycInfo via Ovid; the Cochrane Database of Systematic Reviews; and Epistemonikos. We included systematic reviews that evaluate any type of intervention aimed at impacting opioid prescriber behaviour for adult CNCP in an outpatient setting., Results: We identified three full texts for our review that contained 68 unique primary studies. The main interventions we evaluated were structured prescriber education (one review) and prescription drug monitoring programmes (PDMPs) (two reviews). Due to the paucity of data available, we could not determine with certainty that education interventions improved outcomes in deprescribing. There is some evidence that PDMPs decrease the number of adverse opioid-related events, increase communication among healthcare workers and patients, modify healthcare practitioners' approach towards their opioid prescribed patients, and offer more chances for education and counselling., Conclusions: Our overview explores the possibility of PDMPs as an opioid deprescribing intervention and highlights the need for more high-quality primary research on this topic., (© 2024. Crown.)

Given the increasing use of e-cigarettes and uncertainty surrounding their safety, we conducted a systematic review to determine the effects of e-cigarettes on measures of lung function. We systematically searched EMBASE, MEDLINE, and PsycINFO databases via Ovid, the Cochrane CENTRAL database, and the Web of Science Core from 2004 until July 2021, identifying 8856 potentially eligible studies. A total of eight studies (seven studying immediate effects and one long-term effects, 273 total participants) were included. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) and Cochrane risk of bias tools. These studies suggest that vaping increases airway resistance but does not appear to impact forced expiratory volume in one second (FEV 1) , forced vital capacity (FVC), or FEV 1 /FVC ratio. However, given the limited size and follow-up duration of these studies, larger, long-term studies are required to further determine the effects of e-cigarettes on lung function., (© 2022. The Author(s).)

Background: Depression and anxiety are common in synucleinopathies and often present during prodromal stages, including idiopathic/isolated REM sleep behavior disorder (iRBD). However, the specific profiles of depression/anxiety and their predictive values for phenoconversion remain unclear., Objective: To assess the predominant manifestations, predictive value, and changes over time in depressive and anxiety symptoms in iRBD., Methods: Patients with polysomnography-confirmed iRBD (n = 114) and healthy controls (n = 44) were recruited. The Beck Depression Inventory and Beck Anxiety Inventory were administered at baseline, which was repeated prospectively over follow-up. Factor solutions were generated to delineate symptom clusters within the scales, and to help disentangle primary mood symptoms from other neurodegenerative confounds. Total scores, individual scale items, and factors were evaluated to 1) compare patients and controls, 2) assess progression of symptoms over time, and 3) assess predictive value for phenoconversion., Results: At baseline, iRBD patients had more severe depressive (9.0 = 6.7 vs 5.8 = 4.8) and anxiety (7.0 = 7.9 vs 4.5 = 6.0) symptoms than controls. Increased scores were seen in numerous individual scale items and most scales' factors. For depressive symptoms, there was no progression of total scores or factors over time. However, anxiety scores worsened slightly over prospective follow-up (annual slope = 0.58 points, p < 0.05). Over an average 2.4 = 3.1-year follow-up, 37 patients phenoconverted and 72 remained disease-free. Neither baseline depressive nor anxiety symptoms predicted phenoconversion to clinical neurodegenerative disease., Conclusions: Depressive and anxiety symptoms are common in iRBD. However, they do not predict phenoconversion and show only modest progression over time, solely for anxiety.

Background: Though visual illusions and hallucinations are common in dementia with Lewy bodies (DLB) and Parkinson's disease (PD), they are not typically observed clinically in prodromal stages, including isolated REM sleep behavior disorder (iRBD). False-noise errors on the pareidolia test (seeing faces when none are present) may be an effective measure of susceptibility to future hallucinations in iRBD., Methods: One hundred patients with iRBD underwent the 20-image pareidolia test. Clinical markers were assessed and a neuropsychological battery was administered. An exploratory analysis on the impact of pareidolic errors on phenoconversion was also performed., Results: In our cohort, 17 patients (17%) made false-noise pareidolic errors. These patients had significantly lower total Montreal Cognitive Assesment (MoCA) scores (26.7 ± 2.3 vs. 24.4 ± 2.6, B = -1.88, 95% CI: [-3.17, -0.59]), with lower subcomponent MoCA scores on memory and visuospatial-executive sections. Pareidolic errors were also associated with lower visuospatial, attention/executive, and memory scores on the neuropsychological tests. Furthermore, after 1.6 years follow-up, 3/16 (19%) patients making pareidolic errors had phenoconverted at time of publication compared to 6/71 (8%) patients who did not make errors., Conclusion: Pareidolic errors in patients with iRBD are associated with poorer overall cognition and may indicate higher risk of DLB., Competing Interests: Declaration of competing interest The authors have no financial disclosures in relationship to this manuscript., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Mutations in the glucocerebrosidase (GBA) gene are strongly associated with REM sleep behavior disorder (RBD). It is unclear whether GBA mutations might affect clinical phenotype or rate of phenoconversion to parkinsonism or dementia., Methods: We sequenced GBA in polysomnographic-proven idiopathic RBD (iRBD) patients. The effect of GBA mutations on clinical neurodegenerative markers and phenoconversion rate was assessed., Results: Of 102 patients sequenced, 13 (13%) had GBA mutations and 89 did not. Aside from lower self-reported age of RBD onset in subjects with GBA mutations, no significant differences were observed in any clinical marker between patients with and without mutations. However, GBA mutations were associated with 3.2-fold higher phenoconversion rate from RBD to parkinsonism and/or dementia (95% CI = 1.4-7.3, p = 0.006)., Conclusion: Although GBA mutations do not appear to affect clinical neurodegenerative markers (and thus are not differentiable as an independent subtype of iRBD), they may accelerate the conversion of RBD to defined neurodegenerative synucleinopathy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the impact of a multifaceted, pharmacy-driven, unit-based transitions of care (TOC) program on all-cause 30-day readmission rates and to assess readmission rates in predefined subgroup patient populations. Methods: This prospective study included adult patients who were discharged from the pilot unit from January 5 to January 30, 2015. Patients who expired during hospitalization, left the hospital against medical advice, or transferred to another unit or nonaffiliated hospital were excluded. Possible pharmacist interventions included daily medication profile review, delivery of discharge medications to the bedside, counseling, and communication of a discharge medication list to follow-up providers. Patients had a 30-day follow-up period from the date of discharge to assess for readmission. Results: A total of 131 patients were screened and 94 patients were included. The primary outcome evaluating 30-day readmission rates occurred in 12.8% of patients in the pilot group versus 18.8% of patients in the historical control group ( p = .26). None of the patients who received all possible pharmacist interventions were readmitted. Secondary outcomes assessing readmission rates in predefined subgroup populations as well as length of stay were comparable between the 2 groups. All identified medication discrepancies were resolved prior to discharge. Conclusion: Readmission rates during the pilot were numerically lower but not statistically significant when compared with historical data. Enhancement of the pharmacy-driven TOC services through allocation of additional resources is in progress. Further investigation is warranted to determine the impact of a TOC pharmacist after the service is sustained.

Responding to incidents involving geriatric patients presents multiple challenges and considerations for care. A variety of changes occur to the human anatomy, the physiological functions of the body and emotional state as an individual ages. Understanding these changes, their effect on medication administration and treatment options is important for the EMS provider. The elderly represent a rapidly growing segment of our prehospital patient population. More people will reach age 65 by 2020 than at any other time in the world's history. Many of these individuals will present to the EMS system in need of emergency care and may have multiple chronic conditions that will complicate your patient assessment and available treatment options. Knowing the relationship between aging and a patient's overall health provides the best basis for treating this precious population.

51 kindergarten children participated to assess how various fitness components, 1/2-mile run, the Prudential PACER test, body composition, shoulder stretch, trunk lift, sit-and-reach, curl-up, and flex arm-hang related to motor performance on the Bruininks-Oseretsky test battery including running, speed, agility, balance, bilateral coordination, and strength. All values recorded in the fitness components were compared with standardized motor skill scores. Analysis indicated that 1/2-mile run performance was significantly correlated with body weight and relative body fat, showing that as body weight or relative body fat increased run performance times were slower. Comparisons between the fitness parameters and motor skills indicated that the 1/2-mile run performance also was negatively correlated with measures of balance, bilateral coordination, and strength while the Prudential PACER test was positively correlated with strength. During continuous walk-jog movements (half-mile run) in a relatively homogeneous sample, increases in body size improved balance, bilateral coordination, and strength but negatively affected running during the 1/2-mile fitness test. In more interval-related activities such as the Prudential PACER test, an increase in strength was related to improved performance.

Purpose: The alteration of the pharmacokinetic parameters of the polypeptide BBI through conjugation with palmitic acid was examined., Methods: 125I-BBI or 125I-Pal-BBI was administered iv to 6 week old CF-1 mice at a dose of 3 mg/kg. The mice were sacrificed at 5, 10, 20, 60, 120, 240, 360, and 480 min and the total radioactivity was determined for blood and each organ. The blood was analyzed on a Sephadex G-50 size-exclusion column to determine the amount of intact polypeptide present in the blood. From the amount of intact polypeptide at each time point, the pharmacokinetic parameters were determined., Results: By conjugating three palmitic acids to each BBI molecule, the area under the curve (AUC) and mean residence time (MRT) increase by a factor of 10.8 and 2.8, respectively. There was also a difference in the organ distribution between the two treatments; while 125I-BBI was rapidly cleared from the kidneys, 125I-Pal-BBI was predominantly to the liver. Subsequent studies suggested that the binding of the conjugate to non-albumin serum proteins was most likely the cause of the altered pharmacokinetics., Conclusions: The residence time in the blood and the lipophilicity of BBI were increased upon conjugation with palmitic acid through a reversible disulfide linkage. Pharmacokinetic studies showed an increase in the AUC and a decrease in kidney clearance in palmitic acid conjugates, indicating a potential increase of the therapeutic efficacy of the polypeptide drug.