390 results on '"Simon, H. L."'
Search Results
2. Aseptic Alopecic Nodule of the Scalp (NAAS) Simulating Hoffmann's Disease (HD), Efficacy of Intra-Lesional Corticotherapy: 03 Observations at the Bamako Dermatology Hospital (HDB)
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Tamekou, Simon H. L., primary, Lamissa, Cissé, additional, Mamoudou, Diakité, additional, Fofana, Youssouf, additional, Sissoko, Madou, additional, Traoré, Békaye, additional, Kéita, Alima, additional, Bamba, Ismaila, additional, Moussa, Savné, additional, Koné, Djénéba, additional, Tall, Koureichi, additional, Gassama, Mamadou, additional, and Di, Adama A, additional
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- 2023
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3. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis
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Virmani, Ishita, primary, Oteo, Alberto, additional, Dunn, Michael, additional, Vidler, Daniel, additional, Roper, Clair, additional, Officer, Jane, additional, Hardy, Gareth, additional, Dargan, Paul I., additional, Eddleston, Michael, additional, Cooper, Jamie G., additional, Hill, Simon L., additional, Macfarlane, Rebecca, additional, Keating, Liza, additional, Haden, Mark, additional, Hudson, Simon, additional, and Thomas, Simon H. L., additional
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- 2022
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4. Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial
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Bateman, D Nicholas, Dear, James W, Thanacoody, H K Ruben, Thomas, Simon H L, Eddleston, Michael, Sandilands, Euan A, Coyle, Judy, Cooper, Jamie G, Rodriguez, Aryelly, Butcher, Isabella, Lewis, Steff C, Vliegenthart, A D Bastiaan, Veiraiah, Aravindan, Webb, David J, and Gray, Alasdair
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- 2014
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5. 41st International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 25-28 May 2021, Virtual Meeting
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Liza Keating, Simon Hudson, Paul I. Dargan, Mark Haden, Jane Officer, Jamie G. Cooper, Michael Eddleston, Simon H. L. Thomas, Rebecca Macfarlane, Andy Ketchin, Dan Vidler, Gareth Hardy, Shabanna Issa, and SL Hill
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,medicine.medical_treatment ,Emergency medicine ,Medicine ,General Medicine ,Cannabinoid ,030204 cardiovascular system & hematology ,Toxicology ,business - Published
- 2021
6. Trends in hospital presentations following analytically confirmed synthetic cannabinoid receptor agonist exposure before and after implementation of the 2016 UK Psychoactive Substances Act
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Sam Craft, Michael Dunn, Dan Vidler, Jane Officer, Ian S. Blagbrough, Christopher R. Pudney, Graeme Henderson, Ahmed Abouzeid, Paul I. Dargan, Michael Eddleston, Jamie Cooper, Simon L. Hill, Clair Roper, Tom P. Freeman, and Simon H. L. Thomas
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Cannabinoid Receptor Agonists ,Male ,Psychiatry and Mental health ,Medicine (miscellaneous) ,Humans ,Female ,Hospitals ,United Kingdom ,Chromatography, Liquid ,Personality - Abstract
BACKGROUND AND AIMS: The United Kingdom (UK) Psychoactive Substances Act (PSA), implemented on the 26 th May 2016, made the production, supply and sale of all non-exempted psychoactive substances illegal. The aim of this study was to measure trends in hospital presentations for severe toxicity following analytically confirmed synthetic cannabinoid receptor agonist (SCRA) exposure before and after implementation of the PSA. DESIGN: Observational study.SETTING: Thirty-four hospitals across the UK participating in the Identification of Novel Psychoactive Substances (IONA) study.PARTICIPANTS: A total of 627 (79.9% male) consenting individuals who presented to participating hospitals between July 2015 and December 2019 with severe acute toxicity and suspected novel psychoactive substances exposure.MEASUREMENTS: Toxicological analyses of patient samples were conducted using liquid-chromatography tandem mass-spectrometry. Time-series analysis was conducted on the monthly number of patients with and without analytically confirmed SCRA exposure using Poisson segmented regression.FINDINGS: SCRAs were detected in 35.7% (n = 224) of patients. After adjusting for seasonality and the number of active sites, models showed no clear evidence of an upward or downward trend in the number of SCRA exposure cases in the period before (incidence rate ratio [IRR], 1.12; 95% CI, 0.99-1.26; P = 0.068) or after (IRR, 0.97; 95% CI, 0.94-1.01; P = 0.202) the implementation of the PSA. There was also no clear evidence of an upward or downward trend in non-SCRA exposure cases before (IRR, 1.12; 95% CI, 0.98-1.27; P = 0.105) or after (IRR, 1.01; 95% CI, 0.98-1.04; P = 0.478) implementation of the PSA.CONCLUSIONS: There is no clear evidence of an upward or downward trend in the number of patients presenting to UK hospitals with severe acute toxicity following analytically confirmed synthetic cannabinoid receptor agonist exposure since the implementation of the Psychoactive Substances Act.
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- 2022
7. Acute toxicity from the synthetic cathinone N-ethylpentylone (ephylone) in the United Kingdom
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Clair Roper, David M. Wood, Dan Vidler, Liza Keating, Simon H. L. Thomas, Graham Johnson, Michael Eddleston, SL Hill, Stevan R Emmett, Georgina Blanco, Rebecca Macfarlane, and Paul I. Dargan
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business.industry ,Drug misuse ,Synthetic cathinone ,030208 emergency & critical care medicine ,General Medicine ,Pharmacology ,Toxicology ,humanities ,Acute toxicity ,03 medical and health sciences ,0302 clinical medicine ,Toxicity ,Medicine ,030212 general & internal medicine ,business - Abstract
Acute toxicity caused by New Psychoactive Substances (NPS) has created a significant burden for Emergency Departments (EDs). Here we report characteristics of people presenting with toxicity after ...
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- 2021
8. Trends in hospital presentations following analytically confirmed synthetic cannabinoid receptor agonist exposure before and after implementation of the 2016 UK Psychoactive Substances Act
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Craft, Sam, primary, Dunn, Michael, additional, Vidler, Dan, additional, Officer, Jane, additional, Blagbrough, Ian S., additional, Pudney, Christopher R., additional, Henderson, Graeme, additional, Abouzeid, Ahmed, additional, Dargan, Paul I., additional, Eddleston, Michael, additional, Cooper, Jamie, additional, Hill, Simon L., additional, Roper, Clair, additional, Freeman, Tom P., additional, and Thomas, Simon H. L., additional
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- 2022
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9. THERAPEUTICS: Atypical antipsychotic drugs
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Mackin, Paul and Thomas, Simon H L
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- 2011
10. Cardiovascular complications of poisoning
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Simon H. L. Thomas and Adam J. Potts
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Bradycardia ,Tachycardia ,medicine.medical_specialty ,Cardiac output ,business.industry ,Sinus bradycardia ,General Medicine ,medicine.disease ,Ventricular tachycardia ,Internal medicine ,Ventricular fibrillation ,Vasoplegia ,Heart rate ,cardiovascular system ,medicine ,Cardiology ,medicine.symptom ,business - Abstract
Many poisons affect the heart or blood vessels or their autonomic control; these direct or indirect effects result in cardiovascular complications that contribute substantially to morbidity and mortality in poisoned patients. Direct cardiotoxic effects can alter heart rate, conduction or rhythm, resulting in sinus bradycardia (e.g. β-adrenoceptor blockers, calcium channel blockers) or tachycardia (e.g. sympathomimetic agents such as cocaine) or dysrhythmias such as torsade de pointes, ventricular tachycardia or ventricular fibrillation. Hypertension can be caused by cardiac stimulation or vasoconstriction, and hypotension by hypovolaemia, vasoplegia or poor cardiac output. The cardiovascular impact of poisoning can be exacerbated by pre-existing co-morbidities such as heart, respiratory or liver disease. Here we describe a pragmatic approach to the identification, monitoring and treatment of common cardiovascular complications of poisoning.
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- 2020
11. Pharmacology and toxicology of N-Benzyl-phenylethylamines (25X-NBOMe) hallucinogens
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SL Hill, Adam Potts, and Simon H. L. Thomas
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Hallucinogen ,business.industry ,5-HT2A receptor ,medicine.medical_treatment ,Buccal administration ,Pharmacology ,Serotonergic ,Stimulant ,Toxicology ,Toxicity ,medicine ,Ingestion ,business ,Binding affinities - Abstract
25X-NBOMe compounds are halogenated, phenethylamine-related novel psychoactive drugs, with hallucinogenic and stimulant effects. NBOMes are potent and highly efficacious agonists at the 5HT2a receptor with binding affinities in the low nanomolar range, accounting for their psychoactive and toxic effects. 25I-, 25B-, and 25C-NBOMes are the most frequently encountered compounds; they are typically sold as blotter papers, or in powder, liquid, or tablet forms, and administered by several routes including sublingual or buccal ingestion, nasal insufflation, through smoking or more rarely through intravenous injection. 25X-NBOMes have been identified worldwide and are associated with clinical presentations consistent with sympathomimetic, hallucinogenic, and possibly serotonergic toxidromes. 25X-NBOMEs have been associated with cases of severe toxicity and death, and therefore physicians should remain vigilant for features that may be consistent with toxicity, particularly in those who report ingesting using blotters or LSD. In this chapter, the current understanding of 25X-NBOMe pharmacology and toxicology is reviewed
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- 2022
12. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis
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Ishita Virmani, Alberto Oteo, Michael Dunn, Daniel Vidler, Clair Roper, Jane Officer, Gareth Hardy, Paul I. Dargan, Michael Eddleston, Jamie G. Cooper, Simon L. Hill, Rebecca Macfarlane, Liza Keating, Mark Haden, Simon Hudson, and Simon H. L. Thomas
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General Medicine ,Toxicology - Abstract
Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis (“gold standard”). Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16–75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2–5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8–47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse.
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- 2022
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13. International trends in systemic human exposures to 2,4 dinitrophenol reported to poisons centres
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Gziut, Tomasz, primary and Thomas, Simon H. L., additional
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- 2021
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14. Pharmacological treatment of acquired QT prolongation and torsades de pointes
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Thomas, Simon H. L. and Behr, Elijah R.
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- 2016
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15. Accuracy of substance exposure history in patients attending emergency departments after substance misuse; a comparison with biological sample analysis.
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Virmani, Ishita, Oteo, Alberto, Dunn, Michael, Vidler, Daniel, Roper, Clair, Officer, Jane, Hardy, Gareth, Dargan, Paul I., Eddleston, Michael, Cooper, Jamie G., Hill, Simon L., Macfarlane, Rebecca, Keating, Liza, Haden, Mark, Hudson, Simon, and Thomas, Simon H. L.
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LIQUID chromatography-mass spectrometry ,HOSPITAL emergency services ,SYNTHETIC receptors ,CANNABINOID receptors ,HEROIN ,SUBSTANCE abuse ,TOXICOLOGICAL chemistry ,TOXICITY testing - Abstract
Acute toxicity caused by illicit substance use is a common reason for emergency department (ED) presentation. Knowledge of the substances involved is helpful for predicting and managing potential toxicity, but limited information is available about the accuracy of patient-reported substance exposure. This study assessed the accuracy of the history of exposure in those reporting use of a single substance by comparison with those identified by detailed toxicological analysis, focusing on synthetic cannabinoid receptor agonists (SCRA). Adults (≥16 years) presenting between March 2015 and July 2021 to participating UK hospitals with toxicity after reporting use of a single illicit substance were included. Exposure details were documented from medical records and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry (HRAM LCMS). Sensitivity, specificity, and positive and negative predictive values of the exposure history were calculated by comparison with biological sample analysis ("gold standard"). Single substance exposure was reported for 474 (median age 33 years, IQR: 18 range 16–75, 80% males) patients. Analysis commonly identified multiple substances (Median 3, IQR 2–5). A history of exposure was documented for 121 of 151 patients where a SCRA or metabolite was detected on analysis (sensitivity 80.1%, 95% CI 72.9, 86.2%). Corresponding proportions were lower for 3,4-methylenedioxymethamphetamine (MDMA, 44/70, 62.9%., 95% CI 50.5%, 74.1%), heroin 41/108 (38.0% 95% CI 28.8–47.8%) and cocaine (22/56, 31.3%, 95% CI 20.9, 43.6%). Multiple undeclared substances were detected analytically in most patients reporting single substance use. Clinicians should be alert to the potential presence and toxicity of unreported substances when managing patients presenting after substance misuse. [ABSTRACT FROM AUTHOR]
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- 2023
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16. Detection of flubromazolam in patients with suspected non-medical drug use attending emergency departments in the United Kingdom
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Rebecca Macfarlane, Selina Hines, Simon Hudson, Andrew Ketchin, Michael Eddleston, Simon H. L. Thomas, Simon L Hill, Shabana Issa, Josephine Cashman, and Mark Haden
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Drug ,Adult ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,media_common.quotation_subject ,General Medicine ,Toxicology ,humanities ,United Kingdom ,Substance Abuse Detection ,Benzodiazepines ,Emergency medicine ,Medicine ,Humans ,In patient ,business ,Emergency Service, Hospital ,media_common ,Chromatography, Liquid - Abstract
Non-medical use of novel benzodiazepines has recently become common. Here, we describe the recent frequent detection of flubromazolam in patients attending United Kingdom emergency departments. Adults presenting to participating hospitals with toxicity after suspected drug misuse were studied between March 2015 and January 2021. Clinical features were recorded using consistent methodology and biological samples analysed using liquid chromatography–tandem mass-spectrometry. Flubromazolam and/or its mono-hydroxylated metabolite were detected in samples from 14 of 957 patients, all presenting since July 2020. Reported clinical features included reduced level of consciousness (10), confusion/agitation (6) and acidosis (5) but multiple other substances were detected in all patients. All patients survived to discharge (length of hospital stay 3.0 to 213 h, median 24.1 h). There was no correlation between admission blood/serum flubromazolam concentrations (range 1.7–480.5 ng/ml, median 7.4 ng/ml) and Glasgow Coma Scale or length of hospital stay. In one patient who needed intubation and ventilation for five days, there was an exponential decline in flubromazolam concentrations with time (calculated half-life 39.8 h). Hydroxyl-flubromazolam was also identified at all time points. Flubromazolam has been detected frequently in drug users presenting to UK emergency departments since July 2020. Prolonged toxicity may occur as a result of the long half-life of flubromazolam and the production of metabolites likely to be active.
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- 2021
17. Clinical Toxicology Expert Reviewers 2019
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Ronald I. Kirschner, Nicholas A. Buckley, Simon H. L. Thomas, Jennifer A. Oakes, Betty S. Chan, Donna Seger, Michael E. Mullins, Thomas Y. K. Chan, Martin F. Wilks, Bruno Mégarbane, J Allister Vale, and Steven A. Seifert
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medicine.medical_specialty ,business.industry ,MEDLINE ,Medicine ,Medical physics ,General Medicine ,Clinical toxicology ,Toxicology ,business - Published
- 2020
18. Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study
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F. Martin, Laura Yates, Simon H. L. Thomas, H Dunstan, Jonathan Richardson, Amanda Greenall, and Sally Stephens
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Adult ,medicine.medical_specialty ,Venlafaxine ,010501 environmental sciences ,Abortion ,Toxicology ,01 natural sciences ,Miscarriage ,Cohort Studies ,03 medical and health sciences ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Serotonin and Noradrenaline Reuptake Inhibitors ,030304 developmental biology ,0105 earth and related environmental sciences ,0303 health sciences ,Obstetrics ,business.industry ,Pregnancy Outcome ,Venlafaxine Hydrochloride ,medicine.disease ,Antidepressive Agents ,United Kingdom ,Low birth weight ,Antidepressant ,Small for gestational age ,Female ,medicine.symptom ,business ,medicine.drug ,Cohort study - Abstract
Background Venlafaxine is a serotonin noradrenaline reuptake inhibitor used to treat major depressive episodes and anxiety disorders. The primary aim of this study was to investigate spontaneous abortion risks following gestational exposure. Methods This prospective observational comparative cohort study utilised data collected by the UK Teratology Information Service (UKTIS) between 1995 and 2018. The study sample included 281 venlafaxine exposed pregnancies matched to antidepressant unexposed (n = 1405) and SSRI exposed (n = 843) comparator groups. Results After correction for variation in competing outcome rates and the stage of pregnancy at reporting, no statistically significant differences in the hazard of spontaneous abortion was observed following gestational venlafaxine use compared with either antidepressant unexposed (HR 1.28, 95% CI; 0.850–1.94) or SSRI exposed (HR 1.03, 95% CI; 0.681–1.57) pregnancies. Conclusions No conclusive evidence is provided from this study that venlafaxine increases the risk of adverse pregnancy or fetal outcomes.
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- 2019
19. Rapid and equivalent systemic bioavailability of the antidotes HI-6 and dicobalt edetate via the intraosseous and intravenous routes
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Hill, Simon L, Thomas, Simon H L, Flecknell, Paul A, Thomas, Aurelie A, Morris, Chris M, Henderson, David, Dunn, Michael, and Blain, Peter G
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- 2015
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20. Acute toxicity from the synthetic cathinone
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Georgina, Blanco, Dan, Vidler, Clair, Roper, David M, Wood, Paul I, Dargan, Liza, Keating, Rebecca, Macfarlane, Stevan, Emmett, Graham, Johnson, Michael, Eddleston, Simon L, Hill, and Simon H L, Thomas
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Adult ,Psychotropic Drugs ,Alkaloids ,Humans ,Benzodioxoles ,Butylamines ,United Kingdom - Abstract
Acute toxicity caused by New Psychoactive Substances (NPS) has created a significant burden for Emergency Departments (EDs). Here we report characteristics of people presenting with toxicity after exposure to the synthetic cathinoneAdults presenting to hospital with severe acute toxicity after suspected NPS use were recruited between March 2015 and October 2020. Clinical features were recorded using consistent methodology and biological samples analysed using liquid chromatography-tandem mass-spectrometry.NEP was detected in at least one sample from 9 of 893 patients recruited during the period of study, all presenting between 2016 and 2019 and 8 presenting in southern England. Commonly reported clinical features included tachycardia (6), agitation (6), confusion (6), mydriasis (5), hallucinations (4), acidosis (3) and elevated creatine kinase (3). Co-used drugs, detected in 6 patients, may have contributed to these features, but agitation and hallucinations were also reported in all 3 patients without analytical evidence of co-use.NEP was detected infrequently in episodes of drug toxicity in the UK between 2016 and 2019, especially in southern England. Clinical characteristics of toxicity are similar to those of other cathinones, although co-use of other drugs is common and may contribute to the features observed.
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- 2021
21. Clinical Toxicology review metrics and expert reviewers, 2020
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Donna Seger, Betty S. Chan, Martin F. Wilks, Bruno Mégarbane, Nicholas A. Buckley, J Allister Vale, Steven A. Seifert, Kirk L. Cumpston, Michael E. Mullins, Thomas Y. K. Chan, Simon H. L. Thomas, Ronald I. Kirschner, Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Mégarbane, Bruno
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[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Medical education ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,MEDLINE ,General Medicine ,Clinical toxicology ,Toxicology ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.TOX] Life Sciences [q-bio]/Toxicology ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,[SDV.TOX]Life Sciences [q-bio]/Toxicology ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,[SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Psychology - Abstract
The editors would like to acknowledge and thank all of those who assisted us in 2020 by providing peer review of the submitted manuscripts. Reviewers serve without pay. The time, effort and experti...
- Published
- 2021
22. Detection of flubromazolam in patients with suspected non-medical drug use attending emergency departments in the United Kingdom
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Haden, Mark, primary, Cashman, Josephine, additional, Ketchin, Andrew, additional, Macfarlane, Rebecca, additional, Issa, Shabana, additional, Eddleston, Michael, additional, Hines, Selina, additional, Hudson, Simon, additional, Hill, Simon L., additional, and Thomas, Simon H. L., additional
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- 2021
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23. International trends in systemic human exposures to 2,4 dinitrophenol reported to poisons centres
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Simon H. L. Thomas and Tomasz Gziut
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Male ,medicine.medical_specialty ,education.field_of_study ,Poison Control Centers ,business.industry ,Population ,Significant difference ,Australia ,General Medicine ,Odds ratio ,Toxicology ,Body weight ,Poisons ,United Kingdom ,World health ,Mortality data ,Environmental health ,Case fatality rate ,Epidemiology ,medicine ,Humans ,Female ,2,4-Dinitrophenol ,business ,education - Abstract
BACKGROUND 2,4 dinitrophenol (DNP) is a toxic industrial chemical that reduces body weight and body fat by uncoupling oxidative phosphorylation but at the risk of severe dose-related toxicity. Increases in human DNP exposures have been reported in the United Kingdom, the United States and Australia in recent years, but little information is available for other countries. This study was performed in collaboration with the World Health Organization (WHO) to establish international rates of systemic DNP-related exposures and deaths, as reported to poisons centres. METHODS Poison Centres listed in the WHO Directory of Poison Centres were contacted by email. Data were requested on numbers of enquiries relating to systemic DNP exposure by year, sex and clinical outcome (fatal/non-fatal) for the period January 2010 to September 2020. RESULTS Responses were received from poisons centres in 38 countries which reported 456 separate cases of DNP exposure (303 male, 125 female, 28 sex not reported). Annual case numbers increased from 4 in 2010 to 71 in 2015, with subsequent reductions to 53 in 2019. On a population basis, case rates were higher in Australasia, Europe and North America than in Asia, Africa, and South or Central America, but with substantial differences in rates between countries within the same continent. When mortality data was available, case fatality was high (11.9%, 95% CI 9.0, 15.4) with no significant difference between females (11.3%, 95% CI 6.4, 18.9) and males (12.6%; 95% CI 9.1, 17.1; odds ratio 0.86, 95% 0.45, 1.73, p = 0.72). CONCLUSIONS Substantial increases in calls to poisons centres regarding human systemic exposures to DNP internationally between 2010 and 2015, especially those in Europe, Australia and North America, with fatal outcomes common. Countries affected should consider appropriate additional measures to further reduce the risk of human exposure to this hazardous chemical.
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- 2021
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24. Effect of the UKʼs revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment
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Bateman, Nicholas D., Carroll, Robert, Pettie, Janice, Yamamoto, Takahiro, Elamin, Muhammad E. M. O., Peart, Lucy, Dow, Margaret, Coyle, Judy, Cranfield, Kristina R., Hook, Christopher, Sandilands, Euan A., Veiraiah, Aravindan, Webb, David, Gray, Alasdair, Dargan, Paul I., Wood, David M., Thomas, Simon H. L., Dear, James W., and Eddleston, Michael
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- 2014
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25. Methoxetamine toxicity reported to the National Poisons Information Service: clinical characteristics and patterns of enquiries (including the period of the introduction of the UKʼs first Temporary Class Drug Order)
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Hill, Simon L, Harbon, Siân C D, Coulson, James, Cooper, Gillian A, Jackson, Gill, Lupton, David J, Vale, J Allister, and Thomas, Simon H L
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- 2014
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26. Acute toxicity from the synthetic cathinone N-ethylpentylone (ephylone) in the United Kingdom
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Blanco, Georgina, primary, Vidler, Dan, additional, Roper, Clair, additional, Wood, David M., additional, Dargan, Paul I., additional, Keating, Liza, additional, Macfarlane, Rebecca, additional, Emmett, Stevan, additional, Johnson, Graham, additional, Eddleston, Michael, additional, Hill, Simon L., additional, and Thomas, Simon H. L., additional
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- 2021
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27. International trends in systemic human exposures to 2,4 dinitrophenol reported to poisons centres.
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Gziut, Tomasz and Thomas, Simon H. L.
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POISONS , *POISONING , *HAZARDOUS substances , *BODY weight , *FAT , *OXIDATIVE phosphorylation , *TOXIC substance exposure - Abstract
2,4 dinitrophenol (DNP) is a toxic industrial chemical that reduces body weight and body fat by uncoupling oxidative phosphorylation but at the risk of severe dose-related toxicity. Increases in human DNP exposures have been reported in the United Kingdom, the United States and Australia in recent years, but little information is available for other countries. This study was performed in collaboration with the World Health Organization (WHO) to establish international rates of systemic DNP-related exposures and deaths, as reported to poisons centres. Poison Centres listed in the WHO Directory of Poison Centres were contacted by email. Data were requested on numbers of enquiries relating to systemic DNP exposure by year, sex and clinical outcome (fatal/non-fatal) for the period January 2010 to September 2020. Responses were received from poisons centres in 38 countries which reported 456 separate cases of DNP exposure (303 male, 125 female, 28 sex not reported). Annual case numbers increased from 4 in 2010 to 71 in 2015, with subsequent reductions to 53 in 2019. On a population basis, case rates were higher in Australasia, Europe and North America than in Asia, Africa, and South or Central America, but with substantial differences in rates between countries within the same continent. When mortality data was available, case fatality was high (11.9%, 95% CI 9.0, 15.4) with no significant difference between females (11.3%, 95% CI 6.4, 18.9) and males (12.6%; 95% CI 9.1, 17.1; odds ratio 0.86, 95% 0.45, 1.73, p = 0.72). Substantial increases in calls to poisons centres regarding human systemic exposures to DNP internationally between 2010 and 2015, especially those in Europe, Australia and North America, with fatal outcomes common. Countries affected should consider appropriate additional measures to further reduce the risk of human exposure to this hazardous chemical. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine
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Acheampong, Paul, Cooper, Gill, Khazaeli, Behshad, Lupton, David J., White, Sue, May, Margaret T., and Thomas, Simon H. L.
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- 2013
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29. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial
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Chris Peach Peach, Colin Senior, Lucksy Kottam, Kanthan Theivendran, Christopher Little, Charalambos Charalambous, Saleema Rex, Jamie Candal-Couto, Sally Spencer, Prabhakar Motkur, Matthew Northgraves, Catherine Hewitt, David J. Torgerson, A S C Bidwai, Joseph J. Dias, Sara Rodgers, Iain Macleod, R. Nanda, Harish Shanker, A. J. Brooksbank, Adam Ruman, Damian McClelland, Cormac Kelly, Iona Donnelly, Asim Butt, Jayanti Rai, Barnaby Sheridan, Douglas S. Robinson, Belen Corbacho, Emma Sharp, Philip Rosell, Sunil Garg, Francine Toye, Alison Armstrong, Lorna Goodchild, Cheryl Baldwick, Andrew Carr, Catriona McDaid, Ada Keding, Philip Ahrens, Simon H. L. Thomas, Ravi Ray, Amar Rangan, Richard Hawken, Tim Peckham, Balachandran Venateswaran, Gerry Richardson, Stephen Brealey, Neal Millar, Matthew Kent, Cushla Cooper, Cynthia Srikesavan, Nigel Hanchard, Adnan Saithna, Sarah E Lamb, Charalambos Panayiotou Charalambous, Mark Crowther, Steve Drew, Kapil Kumar, Jodi George Malal, Tim Matthews, and Tom Lawrence
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Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Secondary Care ,Injections, Intra-Articular ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Bursitis ,law ,Clinical endpoint ,Humans ,Medicine ,General anaesthesia ,030212 general & internal medicine ,Range of Motion, Articular ,Adverse effect ,Glucocorticoids ,Physical Therapy Modalities ,business.industry ,Frozen shoulder ,General Medicine ,Middle Aged ,A300 ,medicine.disease ,United Kingdom ,Joint Capsule Release ,Clinical trial ,Treatment Outcome ,Orthopedic surgery ,Physical therapy ,Manipulation, Orthopedic ,Female ,Range of motion ,business - Abstract
Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection. In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508. Between April 1, 2015, and Dec 31, 2017, we screened 914 patients, of whom 503 (55%) were randomly assigned. At 12 months, OSS data were available for 189 (94%) of 201 participants assigned to manipulation (mean estimate 38·3 points, 95% CI 36·9 to 39·7), 191 (94%) of 203 participants assigned to capsular release (40·3 points, 38·9 to 41·7), and 93 (94%) of 99 participants assigned to physiotherapy (37·2 points, 35·3 to 39·2). The mean group differences were 2·01 points (0·10 to 3·91) between the capsular release and manipulation groups, 3·06 points (0·71 to 5·41) between capsular release and physiotherapy, and 1·05 points (-1·28 to 3·39) between manipulation and physiotherapy. Eight serious adverse events were reported with capsular release and two with manipulation. At a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, manipulation under anaesthesia had the highest probability of being cost-effective (0·8632, compared with 0·1366 for physiotherapy and 0·0002 for capsular release). All mean differences on the assessment of shoulder pain and function (OSS) at the primary endpoint of 12 months were less than the target differences. Therefore, none of the three interventions were clinically superior. Arthoscopic capsular release carried higher risks, and manipulation under anaesthesia was the most cost-effective. The National Institute for Health Research Health Technology Assessment programme. [Abstract copyright: Copyright © 2020 The Author(s). Publishedx by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.]
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- 2020
30. Iron overdose epidemiology, clinical features and iron concentration-effect relationships: the UK experience 2008–2017
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G Cooper, Euan A Sandilands, Simon H. L. Thomas, Sally M Bradberry, Gill Jackson, Ted Cheung, Michael Eddleston, Victoria Eagling, John Paul Thompson, D Nicholas Bateman, Catherine Crawford, and L Hawkins
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0301 basic medicine ,medicine.medical_specialty ,Pregnancy ,Pediatrics ,business.industry ,030111 toxicology ,Incidence (epidemiology) ,General Medicine ,Toxicology ,medicine.disease ,Iron poisoning ,Deferoxamine ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Cohort ,Journal Article ,medicine ,Ingestion ,030212 general & internal medicine ,business ,Cohort study ,medicine.drug - Abstract
BACKGROUND: Iron poisoning is potentially serious, but mortality has fallen worldwide since implementation of pack size and packaging restrictions, and changes in iron use during pregnancy. The management of individual cases of overdose remains problematic due to uncertainty about indications for antidote. We examine the epidemiology of iron overdose in hospital cases referred to the UK National Poisons Information Service (NPIS) and evaluate the toxicokinetics of iron in patients ingesting only iron preparations.METHODS: Anonymized hospital referral patient data from the NPIS database were collated for the period 1 January 2008 to 31 July 2017. Information was extracted, where recorded, on type of ingestion [iron alone (single), or combined with other agents (mixed)], reported dose, iron salt, timed iron concentrations and symptoms. In single-agent ingestions, the relationships between reported elemental iron dose, early concentrations (4-6 h), and symptoms were evaluated in teenagers and adults (≥13 years) and children (≤12 years) using standard statistical techniques (correlation and unpaired nonparametric comparisons). In those patients with sufficient sample points (three or more), a simple kinetic analysis was conducted.RESULTS: Of 2708 patients with iron overdoses referred by UK hospitals for advice during the 9.7 years study period, 1839 were single-agent ingestions. There were two peaks in age incidence in single-agent exposures; 539/1839 (28.4%) were CONCLUSION: Single-agent iron exposures reported from UK hospitals were most common in children
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- 2018
31. Tricyclic Antidepressant Poisoning: Cardiovascular Toxicity
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Thanacoody, H. K. Ruben and Thomas, Simon H. L.
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- 2005
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32. Management of the Cardiovascular Complications of Tricyclic Antidepressant Poisoning: Role of Sodium Bicarbonate
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Bradberry, Sally M., Thanacoody, H. K. Ruben, Watt, Barbara E., Thomas, Simon H. L., and Vale, J. Allister
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- 2005
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33. Exposures to automatic dishwashing rinse aids reported to the United Kingdom National Poisons Information Service 2008–2016
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John Paul Thompson, Simon H. L. Thomas, Rachael Day, Allister Vale, Sally M Bradberry, and Euan A Sandilands
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Adult ,medicine.medical_specialty ,Poison Control Centers ,Adolescent ,Detergents ,Eye contact ,Corneal abrasion ,Eye ,Toxicology ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,Internal medicine ,Humans ,Medicine ,Ingestion ,030212 general & internal medicine ,Child ,Skin ,Inhalation ,business.industry ,Age Factors ,Household Products ,Infant ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,medicine.disease ,Rash ,United Kingdom ,Child, Preschool ,Toxicity ,Vomiting ,Female ,medicine.symptom ,business - Abstract
OBJECTIVE To determine the toxicity of rinse aids which are used as drying aids to remove water from crockery. METHODS Enquiries to the UK National Poisons Information Service (NPIS) were analysed retrospectively for the period January 2008 to December 2016. RESULTS There were 855 enquiries relating to 828 patients; children aged 5 years or less accounted for 91.1%. Most exposures occurred from ingestion alone (n = 778, 94.0%), but 26 involved ingestion and other routes: 21 with skin contact, 3 with eye contact, and two with both skin and eye contact. There were a further 24 cases of eye contact alone (n = 20, 2.4%) or skin contact alone (n = 3, 0.4%) and a single case of inhalation alone. The World Health Organisation/International Programme on Chemical Safety/European Commission/European Association of Poison Centres and Clinical Toxicologists (WHO/IPCS/EC/EAPCCT) Poisoning severity score [PSS] was known in 824 of the 828 exposures: 425 of 824 (51.6%) patients did not develop clinical features, 381 (46.2%) had a PSS of 1 (minor toxicity), 15 (1.8%) developed moderate (PSS 2) and 3 (0.4%) severe (PSS 3) toxicity. Vomiting was the most common feature, occurring in over a third of all ingestions (n = 286, 35.8%), followed by coughing (n = 73, 9.1%). A higher proportion of adults than children developed clinical features (72.7% of 33 vs 46.0% of 767, p = .0026), although vomiting occurred significantly more frequently amongst children (p = .0315). Of the 25 eye contact cases, eye pain (n = 8) and/or eye irritation (n = 8) were reported, with or without abnormal vision (n = 7); there were two cases of corneal abrasion. Dermal contact rarely produced features; only 4 of 26 patients reported symptoms including skin rash or burning or numbness at the contact site. CONCLUSIONS Severe clinical features were uncommon following rinse aid exposure; vomiting was the most frequently reported symptom following ingestion.
- Published
- 2017
34. Prescribing without evidence – pregnancy
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Thomas, Simon H. L. and Yates, Laura M.
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- 2012
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35. Developing and delivering clinical toxicology in the UK National Health Service
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Thomas, Simon H. L.
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- 2012
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36. Atypical antipsychotic drugs
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Mackin, Paul and Thomas, Simon H L
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- 2011
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37. Frailty in older patients undergoing emergency colorectal surgery: USA National Surgical Quality Improvement Program analysis
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Simon, H L, primary, Paula, T, additional, Luz, M M, additional, Nemeth, S K, additional, Moug, S J, additional, and Keller, D S, additional
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- 2020
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38. Reductions in emergency department visits after primary healthcare use of the UK National Poisons Information Service
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Muhammad E. M. O. Elamin, Euan A Sandilands, Sally M Bradberry, Simon H. L. Thomas, John Paul Thompson, DA James, Peter Holmes, and G Jackson
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medicine.medical_specialty ,Poison Control Centers ,Adolescent ,Referral ,Primary health care ,Toxicology ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,030225 pediatrics ,Health care ,Information system ,medicine ,Humans ,Child ,Referral and Consultation ,Service (business) ,Primary Health Care ,business.industry ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,Patient Acceptance of Health Care ,medicine.disease ,United Kingdom ,Telephone survey ,Child, Preschool ,Family medicine ,Medical emergency ,Emergency Service, Hospital ,business ,Poisons information - Abstract
Background: Suspected poisoning is a common cause of hospital admission internationally. In the United Kingdom, the National Poisons Information Service (NPIS), a network of four poisons units, provides specialist advice to health professionals on the management of poisoning by telephone and via its online poisoning information and management database, TOXBASE®. Objective: To demonstrate the impact of NPIS telephone advice and TOXBASE® guidance on poisoning-related referrals to emergency departments (ED) from primary healthcare settings. Methods: A telephone survey of primary healthcare providers calling the NPIS and an online survey of TOXBASE® primary care users were conducted to evaluate the effect of these services on poisoning-related ED referrals. Enquirers were asked to indicate whether referral was needed before and after using these information sources. Results: The number of cases considered by enquirers appropriate for ED referral was reduced from 1178 (58.1%) before to 819 (40.4%) after the provision of telephone advice for 2028 cases (absolute reduction 17.7%, 95% CI 14.6, 20.7%) and from 410 (48.2%) before to 341 (40.1%) after consideration of TOXBASE® guidance for 851 cases (absolute reduction 8.1%, 95% CI 3.3, 12.9%). By extrapolating these figures over a full year, it is estimated that these services prevent approximately 41,000 ED referrals annually. Conclusions: The use of NPIS services significantly reduced ED referrals from primary healthcare services with resulting avoided healthcare costs exceeding the current annual NPIS budget. Further studies are needed to evaluate other potential benefits of accessing NPIS services.
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- 2017
39. Toxicity resulting from exposure to oven cleaners as reported to the UK National Poisons Information Service (NPIS) from 2009 to 2015
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Simon H. L. Thomas, Euan A Sandilands, Sally M Bradberry, J Allister Vale, John Paul Thompson, and Rachael Day
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Adult ,Male ,medicine.medical_specialty ,Poison Control Centers ,Time Factors ,Adolescent ,Caustics ,Toxicology ,Severity of Illness Index ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Ingestion ,Cooking ,030212 general & internal medicine ,Child ,Household Articles ,Aged ,Retrospective Studies ,Inhalation Exposure ,Inhalation ,Chemistry ,Poisoning ,Environmental engineering ,Household Products ,Infant ,030208 emergency & critical care medicine ,Skin contact ,Environmental Exposure ,Equipment Design ,General Medicine ,Middle Aged ,United Kingdom ,Accidents, Home ,Child, Preschool ,Toxicity ,Female ,Poisons information - Abstract
Oven cleaning products contain corrosive substances, typically sodium or potassium hydroxide.To determine the reported toxicity from exposure to oven cleaning products.Telephone enquiries to the UK National Poisons Information Service regarding oven cleaning products were analysed retrospectively for the period January 2009 to December 2015.There were 796 enquiries relating to 780 patients. Ninety-six percent of the products involved in the reported exposures contained sodium hydroxide and/or potassium hydroxide. Ingestion alone (n = 285) or skin contact alone (n = 208) accounted for the majority of cases; inhalation alone (n = 101), eye contact alone (n = 97), and multiple routes of exposure (n = 89) accounted for the remainder. Ninety-five percent of patients exposed by inhalation, 94% exposed dermally and 85% reporting eye exposure, developed features of toxicity. Patients exposed by multiple routes developed symptoms in 70% of cases. Only 103 of the 285 patients ingested oven cleaner directly, whereas 182 patients ingested food they considered to have been contaminated with oven cleaner. In 100 of the 103 direct ingestions where the features and World Health Organisation/International Programme on Chemical Safety/European Commission/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score were known, 56 reported symptoms which were minor in 51 cases. The most common features following ingestion were vomiting (n = 26), abdominal pain (n = 22) or pharyngitis (n = 15). Skin burns (n = 91) predominantly involving the hands or arms, occurred in 44% of dermal exposures. Following inhalation, patients frequently developed respiratory features (n = 52) including coughing and chest pain/tightness. Eye pain (n = 43) and conjunctivitis (n = 33) commonly occurred following ocular exposure.Most (71%) patients exposed to an oven cleaner irrespective of the route of exposure developed features of toxicity, though in most cases only minor features developed; moderate or severe features ensued in ∼4%. Those patients exposed dermally, ophthalmically or by inhalation developed features more frequently (≥85%) than those who ingested a product directly (56%).
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- 2017
40. Toxicity from fluoropolymer-containing grout, tile and stone floor sealants reported to the UK National Poisons Information Service 2009–2015
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Sally M Bradberry, John Paul Thompson, Simon H. L. Thomas, Des Henke, Alex Campbell, J Allister Vale, and Euan A Sandilands
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Adult ,Male ,Poison Control Centers ,Adolescent ,Dentistry ,Poison control ,engineering.material ,Toxicology ,Severity of Illness Index ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Occupational Exposure ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Retrospective Studies ,Inhalation exposure ,Inhalation Exposure ,Inhalation ,Waste management ,business.industry ,Sealant ,Grout ,Household Products ,Infant ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,United Kingdom ,Fluorocarbon Polymers ,Aerosol Propellants ,chemistry ,Child, Preschool ,visual_art ,Solvents ,engineering ,visual_art.visual_art_medium ,Fluoropolymer ,Female ,Tile ,business ,Poisons information - Abstract
Grout, tile and floor stone sealants contain a solvent, a water-repelling agent and in the case of aerosols a propellant. The water-repelling agent used is typically a fluoropolymer resin, a silicon-based resin, or a combination of both.To report the clinical course in patients exposed to fluoropolymer-containing sealants referred to the United Kingdom National Poisons Information Service.A retrospective analysis was performed of telephone enquiries received between 2009 and 2015.101 enquiries involving 96 exposures were received. The majority of the exposures (n = 88) occurred when the sealant was delivered from an aerosol. Twelve patients were exposed occupationally and the remainder were exposed while using the product at home. Eighty-nine exposures were as a result of inhalation alone, two followed ingestion, three skin contact and one eye contact; one involved inhalation and eye contact. All 90 patients exposed by inhalation developed clinical features: 31 had a World Health Organisation/International Programme on Chemical Safety/European Commission/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score of 1 (minor toxicity), 51 patients had features of moderate toxicity (PSS 2) and eight were graded PSS 3 (severe poisoning). The most common features were dyspnea (n = 52; 57.8%; 95% CI = 47.0-68.5), chest pain/tightness (n = 34; 37.8%; 95% CI = 27.2-48.4), coughing (n = 27; 30.0%; 95% CI = 20.0-40.0) and sinus tachycardia (n = 11; 12.2%; 95% CI = 4.1-18.2); hypoxemia was present in 20 (22.2%; 95% CI = 13.1-31.4). At the time of the enquiry a chest X-ray had been performed on 15 patients: in eight patients (all of whom were PSS 3) the X-ray was reported as being abnormal and showed bilateral shadowing.This study demonstrates that if fluoropolymer-containing sealants are inhaled then clinical features may occur and in a small proportion (9%) these features may be severe.
- Published
- 2017
41. The impact of an international initiative on exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service between 2008 and 2015
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Michael Eddleston, J Allister Vale, Rachael Day, John Paul Thompson, and Simon H. L. Thomas
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Poison Control Centers ,Stridor ,Detergents ,Poison control ,Capsules ,Toxicology ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Environmental health ,Injury prevention ,medicine ,Forensic engineering ,Humans ,Child ,Depression (differential diagnoses) ,business.industry ,Poisoning ,Small children ,Household Products ,030208 emergency & critical care medicine ,General Medicine ,United Kingdom ,Liquid laundry detergent ,medicine.symptom ,business ,Poisons information - Abstract
Although the majority of those exposed to liquid laundry detergent capsules remain asymptomatic or suffer only minor clinical features after exposure, a small proportion develop central nervous system depression, stridor, pulmonary aspiration and/or airway burns following ingestion or conjunctivitis and corneal ulceration following eye exposure. As a consequence, the International Association for Soaps, Detergents and Maintenance Products (AISE) established a Product Stewardship Programme in Europe, requiring that safety measures be implemented to reduce the visibility of, and restrict access to, these detergent capsules by small children. Implementation occurred in the United Kingdom over several months during the first half of 2013.This study investigated whether the AISE Programme had an impact on the number and severity of exposures reported to the United Kingdom National Poisons Information Service.Telephone enquiries to the National Poisons Information Service relating to liquid laundry detergent capsules were analysed for the period January 2008 to December 2015.While there was a significant difference (p = 0.0002) between the mean number of annual exposures (469.4) reported between 2008 and 2012 and the mean number reported between 2014 and 2015 (403.5), the number of exposures was decreasing steadily prior to implementation of the Programme in 2013, which did not impact this fall from 2013 onwards. In addition, the number of exposures per million units sold was not impacted by the Programme. There was no significant difference (p = 0.68) between the mean number of exposures (11.8) with PSS ≥2 reported between 2008 and 2012 and the mean number (13.0) reported between 2014 and 2015. Although there was a 28.7% decrease between 2010-2012 and 2014-2015 in the number of exposures with PSS ≥2 per million units sold, this decrease was not statistically significant (p = 0.18).There is no evidence that the Product Stewardship Programme had a beneficial impact on the number of exposures reported to the National Poisons Information Service or their severity.
- Published
- 2017
42. Detection of flubromazolam in patients with suspected non-medical drug use attending emergency departments in the United Kingdom.
- Author
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Haden, Mark, Cashman, Josephine, Ketchin, Andrew, Macfarlane, Rebecca, Issa, Shabana, Eddleston, Michael, Hines, Selina, Hudson, Simon, Hill, Simon L., and Thomas, Simon H. L.
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HOSPITAL emergency services ,DRUG utilization ,GLASGOW Coma Scale ,BENZODIAZEPINES ,LENGTH of stay in hospitals ,ACID-base imbalances - Abstract
Non-medical use of novel benzodiazepines has recently become common. Here, we describe the recent frequent detection of flubromazolam in patients attending United Kingdom emergency departments. Adults presenting to participating hospitals with toxicity after suspected drug misuse were studied between March 2015 and January 2021. Clinical features were recorded using consistent methodology and biological samples analysed using liquid chromatography–tandem mass-spectrometry. Flubromazolam and/or its mono-hydroxylated metabolite were detected in samples from 14 of 957 patients, all presenting since July 2020. Reported clinical features included reduced level of consciousness (10), confusion/agitation (6) and acidosis (5) but multiple other substances were detected in all patients. All patients survived to discharge (length of hospital stay 3.0 to 213 h, median 24.1 h). There was no correlation between admission blood/serum flubromazolam concentrations (range 1.7–480.5 ng/ml, median 7.4 ng/ml) and Glasgow Coma Scale or length of hospital stay. In one patient who needed intubation and ventilation for five days, there was an exponential decline in flubromazolam concentrations with time (calculated half-life 39.8 h). Hydroxyl-flubromazolam was also identified at all time points. Flubromazolam has been detected frequently in drug users presenting to UK emergency departments since July 2020. Prolonged toxicity may occur as a result of the long half-life of flubromazolam and the production of metabolites likely to be active. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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43. Exposures to traditional automatic dishwashing tablets and a comparison with exposures to soluble film tablets reported to the United Kingdom National Poisons Information Service 2008–2015
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J Allister Vale, John Paul Thompson, Michael Eddleston, Rachael Day, and Simon H. L. Thomas
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Poison Control Centers ,Adolescent ,Vomiting ,Detergents ,Toxicology ,Skin Diseases ,Young Adult ,03 medical and health sciences ,Eye Injuries ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Ingestion ,030212 general & internal medicine ,Child ,Aged ,Retrospective Studies ,Traditional medicine ,business.industry ,030111 toxicology ,Household Products ,Infant ,General Medicine ,Middle Aged ,United Kingdom ,Solubility ,Child, Preschool ,medicine.symptom ,business ,Soluble Film ,Poisons information ,Tablets - Abstract
Traditional automatic dishwashing tablets are contained within an external wrapper that requires removal prior to use.To determine the toxicity of traditional tablets and to compare this with our previously reported experience of soluble film dishwashing tablets.Telephone enquiries regarding traditional tablets were analysed retrospectively for the period January 2008 to December 2015.Traditional tablets: There were 503 enquiries relating to 492 patients who had been exposed to a traditional tablet. Most involved children aged 5 years or less (87.4%). The majority (78.6%) of patients did not develop symptoms after exposure; 21.1% developed minor (PSS 1) symptoms while one patient developed moderate features. Exposure occurred predominantly as a result of ingestion (n = 476, 96.7%); the most common feature in symptomatic patients (n = 99, 20.8%) was vomiting (70 [14.7%] cases). Significantly (p 0.0001) more adults (44.9% of 49 adults; 95% CI = 31.9-58.7) were reported with features than children (18.2% of 434; 95% CI = 14.9-22.1). There were five cases of eye contact which resulted in eye pain in two patients and eye irritation in another. Only one of 11 patients exposed dermally developed features (a rash around the mouth). Comparison with soluble film exposures: The percentage of patients that were reported with clinical symptoms following ingestion of a soluble film dishwashing tablet (31.7% of 473 patients; 95% CI = 27.7-36.0) was significantly greater (p 0.0001) than that for a traditional tablet (20.9% of 483 patients; 95% CI = 17.5-24.8). Vomiting was the most commonly reported feature and occurred significantly (p 0.0001) more frequently amongst patients who had ingested a soluble film tablet (25.5%; 95% CI = 21.8-29.6) than a traditional tablet (14.7%; 95% CI = 11.8-18.1).Exposure to both traditional and soluble film tablets only rarely produced clinically significant symptoms (PSS ≥2). However, ingestion of a soluble film tablet was significantly more likely to result in clinical features than ingestion of a traditional tablet.
- Published
- 2016
44. Liquid laundry detergent capsules (PODS): a review of their composition and mechanisms of toxicity, and of the circumstances, routes, features, and management of exposure
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Sally M Bradberry, Simon H. L. Thomas, J Allister Vale, and Rachael Day
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Detergents ,Poison control ,Capsules ,Toxicology ,03 medical and health sciences ,Eating ,Surface-Active Agents ,0302 clinical medicine ,Seizures ,Injury prevention ,medicine ,Humans ,030212 general & internal medicine ,Laryngospasm ,Depression (differential diagnoses) ,business.industry ,Poisoning ,030208 emergency & critical care medicine ,Metabolic acidosis ,General Medicine ,medicine.disease ,Thermal burn ,Europe ,Anesthesia ,Child, Preschool ,North America ,Vomiting ,Hyperlactatemia ,medicine.symptom ,business ,Acidosis ,Intubation - Abstract
Introduction: Liquid laundry detergent capsules (also called single-use detergent sacs; laundry pods; laundry packets) have become an increasingly popular household product worldwide. Objectives: To review the composition and mechanisms of toxicity of liquid laundry detergent, capsules, and the circumstances, routes, clinical features (and impact of packaging changes) and management of exposure. Methods: The databases PubMed and EMBASE were searched using the terms: "detergent" and "capsule", "pod", "pac" or "sac" combined with "poison", "ingest", "expos" but not "animal" or "in vitro" or "bacteria". The searches yielded 289 articles, of which 186 were excluded: 38 duplicates, 133 not relevant, 10 abstracts which had been published as a paper and 5 non-English language articles. The bibliographies of relevant articles were hand-searched which yielded 14 additional citations. Searching of abstracts from scientific meetings produced five additional citations. A total of 122 publications were relevant to the objectives of the review. Capsules and composition: Capsules typically contain anionic surfactants (20-35%), non-ionic surfactants (10-20%), propylene glycol (8-20%) and ethanol (2-5%) within a water-soluble polyvinyl alcohol membrane. Mechanisms of toxicity: Non-ionic surfactants are the primary mechanism, though anionic surfactants, ethanol and propylene glycol may also contribute. Circumstances of exposure: The majority (60%) of children are exposed when the capsule is removed from its original container. Routes of exposure: Ingestion is the most common (>85%); ocular ( 90% are minor. In those with features, vomiting occurs in some 50%; coughing and drowsiness are reported in
- Published
- 2019
45. National audit of antidote stocking in UK emergency departments
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James Kent, Lindsay McClure, Paul I. Dargan, Sheena Vithlani, James T Harnett, Simon H. L. Thomas, and Shabnam Sobhdam
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business.industry ,Antidotes ,Pharmacy ,Audit ,Emergency department ,medicine.disease ,030226 pharmacology & pharmacy ,Hospitals ,United Kingdom ,Clinical pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Stocking ,Procurement ,medicine ,Humans ,030212 general & internal medicine ,Medical emergency ,Business ,General Pharmacology, Toxicology and Pharmaceutics ,National audit ,Emergency Service, Hospital ,Pharmacy Service, Hospital ,Poisons information ,Original Research - Abstract
Background Previous audits of antidote stocking in UK hospitals have demonstrated variable but improving compliance with joint Royal College of Emergency Medicine and National Poisons Information Service guidance on antidote availability in emergency departments. The guidance was updated in 2017. Aim To provide a current picture of compliance with the 2017 antidote guidance and compare this to previous audits. Methods Questionnaires were distributed to all hospitals in the UK with an emergency department via medicines information and regional pharmacy procurement networks. Data were collected on availability and stock levels of category A (immediately available) and category B (available within 1 hour) antidotes. Additionally, data were collected on holdings of category C (held supra-regionally) antidotes and arrangements for sourcing these if not stocked locally. Results 233 hospitals were surveyed and 178 replies (76.4%) were received. There were 73 hospitals (41.7%) fully compliant with guidance for category A, 34 hospitals (19.1%) for category B and 18 hospitals (10.1%) for both categories A and B antidotes. Few hospitals stocked category C antidotes (1.1%–34.8%). Evidence of formalised regional holding arrangements for category C antidotes, as advised in the guidance, was noted in some areas but many regions remain without such agreements. Conclusions Most hospitals remain not fully compliant with stocking recommendations for categories A and B antidotes, with limited recent improvement. Category C antidotes are stocked by few hospitals although awareness of where these can be sourced appears to be increasing. Emergency departments should review their antidote stocking arrangements to ensure compliance with guidance. Formal arrangements for stocking of the more rarely used category C antidotes at a regional level are also required, where not already in existence, in order to assure their availability in an equitable way across the country.
- Published
- 2019
46. Safety and Efficacy of the SNAP 12-hour Acetylcysteine Regimen for the Treatment of Paracetamol Overdose
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David M. Wood, James W. Dear, Muhammad E. M. O. Elamin, Emma E. Morrison, Ruben Thanacoody, Euan A Sandilands, Janice Pettie, Michael Eddleston, David J. Webb, Paul I. Dargan, Ben Francis, Simon H. L. Thomas, Robert W. Hunter, and Thomas M Caparrotta
- Subjects
Drug-induced liver injury ,NAPQI ,Clinical practice ,01 natural sciences ,Paracetamol overdose ,Acetylcysteine ,03 medical and health sciences ,INR, International normalised ratio ,0302 clinical medicine ,Hospital discharge ,medicine ,RIE, Royal Infirmary of Edinburgh ,030212 general & internal medicine ,0101 mathematics ,SNAP, Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning ,Liver injury ,lcsh:R5-920 ,MHRA, Medicines and Healthcare Products Regulatory Agency's ,NAC ,business.industry ,Medical record ,010102 general mathematics ,Snap ,STH, St Thomas' Hospital, London ,General Medicine ,medicine.disease ,NAPQI, N‑acetyl‑p‑benzoquinone imine ,Regimen ,Paracetamol ,Anesthesia ,RVI, The Royal Victoria Infirmary, Newcastle ,NAC, Acetylcysteine ,ALT, Alanine transaminase activity ,lcsh:Medicine (General) ,business ,Acute liver failure ,Research Paper ,medicine.drug - Abstract
Background: Acetylcysteine (NAC) is effective at preventing liver injury after paracetamol overdose. The Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning (SNAP) Study demonstrated that a 12 h NAC regimen was associated with fewer adverse drug reactions compared with the standard 21 h regimen. Here, we describe the clinical effectiveness of the SNAP NAC regimen. Methods: The SNAP regimen, consisting of intravenous NAC 100 mg/kg over 2 h then 200 mg/kg over 10 h, was introduced to treat all paracetamol overdose patients at the Royal Infirmary of Edinburgh, the Royal Victoria Infirmary, Newcastle and St Thomas' Hospital, London. Patient data were prospectively and systematically collected before and after the change in treatment (total patients N = 3340, 21 h N = 1488, SNAP N = 1852). Health record linkage was used to determine patient outcome after hospital discharge. Findings: There was no difference in liver injury or liver synthetic dysfunction between regimens. Hepatotoxicity (peak ALT > 1000 U/L) occurred in 64 (4.3%) and 67 (3.6%) patients, respectively, in the 21 h and SNAP groups (absolute difference −0.7%, 95% CI −2.1 to 0.6). Multivariable logistic regression did not identify treatment regimen as an outcome-associated factor. No patients were readmitted to hospital with, or died from, liver failure within 30 days of discharge. Anti-histamine treatment (for NAC anaphylactoid drug reactions) was prescribed for 163 (11.0%) patients with the 21 h regimen and 37 (2.0%) patients with the SNAP regimen (absolute difference 9.0% (95% CI 7.3 to 10.7)). Interpretation: In clinical use the SNAP regimen has similar efficacy as standard therapy for preventing liver injury and produces fewer adverse reactions. Keywords: Acute liver failure, Paracetamol, NAC, Clinical practice, Drug-induced liver injury
- Published
- 2019
47. A review of 4652 exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service 2008-2018
- Author
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Simon H. L. Thomas, Sally M Bradberry, Euan A Sandilands, G Jackson, J Allister Vale, Rachael Day, John Paul Thompson, and DJ Lupton
- Subjects
Adult ,Poison Control Centers ,Injury control ,Adolescent ,Accident prevention ,Detergents ,Poison control ,Toxicology ,Severity of Illness Index ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Surveys and Questionnaires ,Humans ,030212 general & internal medicine ,Child ,Aged ,Waste management ,Household Products ,030208 emergency & critical care medicine ,General Medicine ,Oxygen deficiency ,Middle Aged ,United Kingdom ,Child, Preschool ,Liquid laundry detergent ,Business ,Poisons information - Abstract
Introduction: Liquid laundry detergent capsules contain concentrated liquid laundry detergent in a water-soluble polyvinyl alcohol membrane.Objective: To review 4652 exposures reported to the Unite...
- Published
- 2019
48. Acute toxicity following analytically confirmed use of the novel psychoactive substance (NPS) methiopropamine. A report from the Identification of Novel psychoActive substances (IONA) study
- Author
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SL Hill, Jane Officer, Michael Eddleston, Joanna C. White, Simon H. L. Thomas, Paul I. Dargan, David M. Wood, and Michael Dunn
- Subjects
Adult ,Male ,Adolescent ,Substance-Related Disorders ,Amphetamine-Related Disorders ,Psychoactive substance ,Thiophenes ,Pharmacology ,Toxicology ,Methamphetamine ,chemistry.chemical_compound ,Young Adult ,Methiopropamine ,Tandem Mass Spectrometry ,Medicine ,Humans ,business.industry ,General Medicine ,Length of Stay ,Middle Aged ,Acute toxicity ,United Kingdom ,Substance Abuse Detection ,chemistry ,Identification (biology) ,Central Nervous System Stimulants ,Female ,business - Abstract
Objective: Use of the New Psychoactive Substance (NPS) methiopropamine was first reported in 2011, but there are limited data on its acute toxicity. We report 11 patients presenting with analytical...
- Published
- 2019
49. Factors influencing the ocular pulse — the heart rate
- Author
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Trew, David R., James, C. Bruce, Thomas, Simon H. L., Sutton, Richard, and Smith, Stephen E.
- Published
- 1991
- Full Text
- View/download PDF
50. Effects of sex on the pharmacokinetic and pharmacodynamic properties of quinidine
- Author
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El-Eraky, Hala and Thomas, Simon H. L.
- Published
- 2003
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